The quality of evidence is downgraded by study limitations (lack of allocation concealment and lack of blinding) and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 8 studies with a total of 719 subjects with acute or chronic viral myocarditis. Three of the studies included children (n=312). Viral detection was performed in 38% of participants, among whom 56% had positive results. All participants were randomly assigned to corticosteroids treatment groups or control groups. Conventional treatments were applied to all participants. Corticosteroids were applied alone, or with other immunosuppressive medicines which included azathioprine and cyclosporine. Chinese traditional medicines were applied to treatment groups in all 3 Chinese RCTs.
Overall mortality was 37.7%; and mortality was not reduced with corticosteroids either for children or for adults (RR 0.93, 95% CI 0.70 to 1.24). At 1 to 3 months follow-up, left ventricular ejection fraction (LVEF) was higher in the corticosteroids group compared to the control group (MD 7.36%, 95% CI 4.94 to 9.79), but there was substantial heterogeneity. Benefits were observed in LVEF in two studies with 200 children given corticosteroids (MD 9.00%, 95% CI 7.48 to 10.52). New York Heart Association (NYHA) class and left ventricular end-stage systole diameter (LVESD) were not affected. Creatine phosphokinase (CPK) (MD -104.00 U/L, 95% CI -115.18 to -92.82), isoenzyme of creatine phosphate MB (CKMB) (MD 10.35 U/L, 95% CI 8.92 to 11.78), were reduced in the corticosteroids group compared to the control group. There were insufficient data on adverse events.
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