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The Ineffectiveness of Immunosuppressive Therapy in Lymphocytic Myocarditis: An Overview

Amit Garg, MD; Judy Shiau, MDCM; and Gordon Guyatt, MD, MSc
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From McMaster University, Hamilton, Ontario, Canada Acknowledgments: The authors thank R. Garg, PhD; B. Maisch, MD; F. Moniz, MD; P. Powles, MD; and P. Tanser, MD. Requests for Reprints: Judy Shiau, MDCM, Department of Medicine, McMaster University, Room 3W10 B, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; e-mail, shiauj@fhs.mcmaster.ca. Current Author Addresses: Drs. Garg, Shiau, and Guyatt: Department of Medicine, McMaster University, Room 3W10 B, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(4):317-322. doi:10.7326/0003-4819-129-4-199808150-00009
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Background: The use of immunosuppressive therapy for myocarditis is controversial.

Purpose: To review the literature on the effectiveness of immunosuppressive therapy in biopsy-proven lymphocytic myocarditis.

Data Sources: Two authors independently searched MEDLINE and other medical databases from 1980 to 26 June 1997.

Study Selection: Randomized, controlled trials; matched-cohort studies; and case–control studies of patients with biopsy-proven myocarditis (Dallas criteria or a mean of ≥ 2.5 lymphocytes per high-power field) for which any form of immunosuppressive treatment was used. The outcomes of interest were mortality and change in left ventricular ejection fraction.

Data Extraction: 6 of 374 studies satisfied the selection criteria.

Data Synthesis: In survivors, left ventricular function in myocarditis improved approximately 10% over 6 months without immunosuppressive treatment. Prednisone alone did not improve survival (P >0.2) or left ventricular function (P >0.11). Prednisone combined with azathioprine or cyclosporine did not improve survival (P >0.2) or left ventricular function (P >0.2) in three studies. However, one small matched-cohort study showed improvement in children (P <0.01). Neither interferon nor thymic hormone improved survival or left ventricular function.

Conclusions: Immunosuppressive therapy is ineffective in lymphocytic myocarditis. Current therapy in lymphocytic myocarditis seems to be limited to supportive measures or transplantation.





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