Successful Triple Combination Immunosuppressive Therapy with Prednisolone, Cyclosporine, and Mycophenolate Mofetil to Treat Recurrent Giant Cell Myocarditis

Akita, Tomomi; Mori, Shigeo; Ōnishi, Akira; Hara, Shigeo; Yamada, Haruhi; Nagasawa, Akira; Shimoura, Hiroyuki; Ooka, Junichi; Tanaka, Hidekazu; Hirata, Ken–ichi

doi:10.2169/internalmedicine.2471-18

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…For example, immediate immunosuppressive treatment with glucocorticoids and subsequent tapering to low maintenance dose may be initiated based on evidence of giant cell FM, cardiac sarcoidosis, and eosinophil myocarditis resulting in better outcomes. 51 , 52 However, the application of glucocorticoids in the treatment of lymphocyte FM remains debatable, notably, disease caused by viral infections. Evidence against the use of glucocorticoids in the treatment of lymphocyte FM reflects concern the virus infection may worsen and spread due to glucocorticoid-induced immunosuppression.…”

Section: Pathological Classifications Of Fmmentioning

confidence: 99%

Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes

Hang

Chen

Seubert

et al. 2020

Sig Transduct Target Ther

104

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Fulminant myocarditis (FM) is characterized by a rapid progressive decline in cardiac function and a high mortality rate. Since the first report of FM patients in the 1980s, several clinical trials and research studies have been published increasing our knowledge regarding FM. Currently, the diagnosis of FM depends on various techniques including electrocardiography, echocardiography, endomyocardial biopsy, and cardiac magnetic resonance. The development of mechanical circulation support (MCS) devices and progress in our understanding of the pathophysiological mechanisms underlying FM, treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach. The core mechanism underlying the development of FM is the occurrence of an inflammatory cytokine storm. This review provides a comprehensive account of the current understanding of FM pathophysiology and knowledge regarding its etiology, pathophysiology, treatments, and outcomes.

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Section: Pathological Classifications Of Fmmentioning

confidence: 99%

Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes

Hang

Chen

Seubert

et al. 2020

Sig Transduct Target Ther

104

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“…The use of cyclophosphamide in ANCA-associated vasculitis with cardiac involvement is still recommended [61]; however, in other clinical scenario, the use of cyclophosphamide is limited by its potential cardiotoxicity [62]. Cyclosporine is primarily used in combination with steroids and MTX to control life-threatening cases of giant cell myocarditis [63].…”

Section: Other Immunosuppressive Drugsmentioning

confidence: 99%

Therapeutic strategies for virus-negative myocarditis: a comprehensive review

Luca

Campochiaro

Sartorelli

et al. 2020

European Journal of Internal Medicine

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“…Подобный опыт есть и в отношении одной из самых тяжелых форм аутоиммунного миокардита -гигантоклеточного [6]: диагноз поставлен при ЭМБ, из системных проявлений имелся язвенный колит; крайняя степень систолической дисфункции (ФВ 6%) потребовала имплантации желудочкового аппарата вспомогательного кровообращения, пульстерапии метилпреднизолоном с последующим назначением преднизолона 50 мг/сут., циклоспорина 50 мг/сут. и в/в иммуноглобулина, стандартная терапия ХСН.…”

Section: Discussionunclassified

“…Раз в полгода и в конце наблюдения проводилось контрольное обследование (оценка функционального статуса, стандартные анализы крови, определение уровня антикардиальных антител, ЭхоКГ, суточное мониторирование электрокардиограммы по Холтеру). ного к стандартной ИСТ гигантоклеточного миокардита [6].…”

Section: рукопись полученаunclassified

Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis

et al. 2021

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Aim. To study the efficacy and safety of mycophenolate mofetil (MM) in combination with corticosteroids in the treatment of lymphocytic myocarditis in comparison with a standard combination of corticosteroids and azathioprine.Material and methods. The study included 46 patients aged 18 years and older with severe and moderate lymphocytic myocarditis (men, 34; women 12; mean age, 53,5±13,0 years). The diagnosis was verified using endomyocardial biopsy. Symptom duration averaged 9,5 [4; 20.25] months. All patients had class 3 [2,75; 3] heart failure (HF). The main group included 29 patients who received MM 2 g/day, including six patients — instead of azathioprine, which was canceled due to cytopenia (n=3) or insufficient effect (n=3). The comparison group included 17 patients who received azathioprine 150 [100; 150] mg/day. Patients of both groups also received methylprednisolone at a starting dose of 24 [24; 32] and 24 [24; 24] mg/day and standard HF therapy. In 7/2 patients, the parvovirus B19 genome was detected in the myocardium. In all cases, an increase in anticardiac antibody titers was evidence of immune activity. The average follow-up period was 24 [12; 54] months (at least 6 months).Results. The groups were completely comparable in age, initial characteristics and standard drug therapy. In both groups, a comparable significant increase in the ejection fraction (EF) was noted as follows: from 31,2±7,6 to 44,7±8,3% and from 29±9,1 to 46±11,9% (p<0,001). An excellent response to treatment (an increase in EF by 10% or more) was noted in 68,2% and 66,7% of patients, a good response (by 9-5%) — in 27,3% and 14,3%, a poor response (an increase in less than 5% or a decrease in EF) — in 4,5% and 19,0%, respectively. In both groups, we noted the same significant (p<0,01) decrease in pulmonary artery systolic pressure (36,3±12 to 28,1±6,1 mm Hg in the MM group and from 44,1±8,5 to 30,7±12,1 mm Hg in the azathioprine group), left ventricular (LV) end-diastolic dimension (from 6,4±0,6 to 6±0,7 cm and from 6,2±0,5 to 5,8±0,6 cm), LV end-diastolic volume (from 188,7±55,2 to 178,8±57,1 ml and from 167,8±47,5 to 163,3±61,8 ml), LV end-systolic volume (from 130,3±44,1 to 98,4±32 ml and from 118,1±39 to 94,1±46 ml), left atrial volume (from 98,3±30,3 to 86,7±32,6 ml and from 105±27,4 to 91,2±47,3 ml, p<0,05), as well as mitral regurgitation grade. The incidence of deaths was 2 (6,9%) and 2 (8,7%), transplantation — 1 (3,4%) and 1 (4,3%) patients, death+transplantation end point — 3 (10,3%) and 2 (11,8%) without significant differences between the groups. The presence of the parvovirus B19 genome did not affect the results of treatment. The incidence of infectious complications was comparable in both groups (in one case, MM was completely canceled), no new cytopenia cases were noted during the follow-up period.Conclusion. In patients with moderate and severe virus-negative (except for parvovirus B19) lymphocytic myocarditis, the combination of moderate-dose corticosteroids with mycophenolate mofetil 2 g/day is at least no less effective than the standard regimen of immunosuppressive therapy. There was a tendency towards a more pronounced decrease in anticardiac antibody titers in combination with better tolerance (no cases of cytopenia) in MM group. MM in combination with corticosteroids can be recommended as an alternative treatment regimen for lymphocytic myocarditis.

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Successful Triple Combination Immunosuppressive Therapy with Prednisolone, Cyclosporine, and Mycophenolate Mofetil to Treat Recurrent Giant Cell Myocarditis

Cited by 9 publications

References 13 publications

Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes

Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes

Therapeutic strategies for virus-negative myocarditis: a comprehensive review

Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis

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