section name header

Evidence summaries

Intravenous Immunoglobulin for Viral Myocarditis

There is insufficient evidence on the effect of intravenous immunoglobulin (IVIG) for the management of presumed viral myocarditis. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), by indirectness (differences between the population of interest and those studied: there is doubt, whether all enrolled participants truly had acute myocarditis), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 189 subjects with a clinical diagnosis of acute myocarditis.

Adults: The first study included 62 subjects with recent-onset dilated cardiomyopathy randomly assigned to receive IVIG or an equivalent volume of 0.1% albumin. There was no statistically significant difference in event-free survival (risk of death, cardiac transplant, or left ventricular assist device) between groups (RR 1.76, 95% CI 0.48 to 6.40). The second study included 41 subjects with acute myocarditis randomised to either high-dose IVIG (1 to 2 g/kg over 2 days) or no treatment. The IVIG group reported greater survival time after 60 days (P < 0.01). In the pooled analysis, no difference in overall survical was observed (RR 0.91, 95% CI 0.23 to 3.62, 2 studies, n=103).The effect of IVIG on LVEF (pooled MD 0.01, 95% CI 0.06 to 0.05; 2 studies, n=103), on functional capacity, assessed by peak oxygen consumption at 12 months (MD 0.80, 95% CI 4.57 to 2.97; 1 study, n=48), and on failure to attain complete recovery (RR 0.46, 95% CI 0.19 to 1.14; 1 study, n=41) were uncertain.

Children: 86 children presenting with acute myocarditis were randomly assigned to 1 g/kg IVIG daily for 2 consecutive days or placebo followed by echocardiography 1 and 6 months post randomisation. No difference in mortality was observed after 6 months (RR 0.48, 95% CI 0.20 to 1.15) between IVIG and control. The effect was also uncertain for improvement in LVEDD and LVSF after 6 months (LVEDD MD 4.00, 95% CI 9.52 to 1.52; LVSF no raw data).

References

  • Robinson J, Hartling L, Vandermeer B et al. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev 2020;(8):CD004370. [PubMed]

Primary/Secondary Keywords