The ineffectiveness of immunosuppressive therapy in lymphocytic myocarditis: an overview.

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 > or = 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.