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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00430

Immunosuppressive treatment for myocarditis in the pediatric population: a meta analysis

  • 1Renmin Hospital, Faculty of Medical Sciences, Wuhan University, China

The use of immunosuppressants in the treatment of myocarditis in children remains controversial. The aim of this meta-analysis is to summarize the current empirical evidence for immunosuppressive treatment for myocarditis in the pediatric population. We searched the Pubmed, MEDLINE and EMBASE for articles to identify studies analyzing the efficiency of immunosuppressive treatment in the pediatric population. Pooled estimates were generated using fixed or random-effect models. Heterogeneity within studies was assessed using Cochran's Q and I2 statistics. Funnel plots and Begg's rank correlation method were constructed to evaluate publication bias. Sensitivity analyses were also conducted to evaluate the potential sources of heterogeneity. After a detailed screening of 159 studies, six separate studies were identified, with 181 patients in the immunosuppressive treatment group and 199 in the conventional treatment group. The immunosuppressive treatment group showed a significant improvement in left ventricular ejection fraction (LVEF)[mean difference 1.10, 95% CI :0.41, 1.79] and significantly decreased left ventricular end diastolic dimension (LVEDD)[mean difference -0.77mm, 95% CI :-1.35 to -0.20mm] when compared to the conventional treatment group. Furthermore, the risk of death and heart transplant in conventional treatment was significantly higher than immunosuppressive treatment group (RR:4.74; 95%CI:2.69, 8.35). No significant heterogeneity across the studies was observed. There was no evidence of publication bias when assessed by Begg's test.
Conclusions: There may be a possible benefit, in the short term, to the addition of immunosuppressive therapy in the management of myocarditis in the pediaatric population. However, further prospective investigation is warranted to the validate this finding.Children with myocarditis seem to benefit from immunosuppressive therapy. Immunosuppressive treatment of acute myocarditis in the pediatric population is associated with improved recovery of left ventricular function and with a tendency to better survival.

Keywords: Immunosuppressive treatment, Myocarditis, pediatric, meta analysis, left ventricular function

Received: 22 May 2019; Accepted: 07 Oct 2019.

Copyright: © 2019 He, Li and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Bing He, Renmin Hospital, Faculty of Medical Sciences, Wuhan University, Wuhan, China, hb0701@sina.com