Efficacy and safety of dexamethasone in the treatment of viral myocarditis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHEN Zhe , HE Sheng , SU Ziwen , SUN Zhan

The First Clinical College, Chongqing Medical University, Chongqing 400016, P.R. China;

Corresponding author：

CHEN Zhe, Email: 522912544@qq.com

Keywords：

Dexamethasone; Viral myocarditis; Efficacy; Safety; Meta-analysis

DOI：

10.7507/1672-2531.202105030

Video：

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Objective To systematically review the efficacy and safety of dexamethasone in the treatment of viral myocarditis.Methods The Cochrane Library, PubMed, EMbase, Biosis Preview, Web of Science, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on dexamethasone for patients with viral myocarditis from inception to April 30^th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software.Results A total of 7 RCTs involving 749 patients were included. The results of meta-analysis showed that the dexamethasone treatment group exhibited an increased efficacy rate (RR=1.26, 95%CI 1.18 to 1.34, P<0.000 01), decreased levels of C-reactive protein (CRP) (MD=−11.49, 95%CI −19.25 to −3.72, P=0.004), cardiac troponin I (cTnI) (MD=−26.14, 95%CI −40.82 to −11.47, P=0.0005), and creatine kinase MB (CK-MB) (MD=−20.06, 95%CI −28.35 to −11.77, P<0.000 01), and a decreased adverse event rate (RR=0.40, 95%CI 0.24 to 0.65, P=0.000 3).Conclusions Current evidence shows that dexamethasone can significantly improve the efficacy rate, reduce the levels of CRP, cTnI, and CK-MB, and reduce the incidence of adverse events in patients with viral myocarditis. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify above conclusions.

Citation： CHEN Zhe, HE Sheng, SU Ziwen, SUN Zhan. Efficacy and safety of dexamethasone in the treatment of viral myocarditis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(9): 1043-1047. doi: 10.7507/1672-2531.202105030 Copy

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2.	Verma V, Sondhi S, Sharma R, et al. COVID-19 associated viral myocarditis: does it exist? Monaldi Arch Chest Dis, 2020, 90(4): 561-562.
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10.	王薇. 静注丙种球蛋白联合糖皮质激素治疗急性重症病毒性心肌炎的临床研究. 青岛: 青岛大学, 2017.
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17.	张金霞, 宫临征. 地塞米松在治疗病毒性心肌炎的临床疗效分析. 中国继续医学教育, 2015, 7(13): 163-164.
18.	张颖芳. 利巴韦林、大剂量维生素 C 及地塞米松治疗小儿急性病毒性心肌炎的效果探析. 当代医药论丛, 2017, 15(3): 35-36.
19.	徐常娟, 任燕. 分析地塞米松在治疗病毒性心肌炎中的临床疗效. 世界最新医学信息文摘(连续型电子期刊), 2018, 18(A1): 39-40.
20.	苗春娇. 地塞米松在治疗病毒性心肌炎中的临床疗效评价. 中国现代药物应用, 2019, 13(22): 138-139.
21.	陈敏, 陈淑红, 侯林涛, 等. 大剂量维生素 C 辅助利巴韦林与地塞米松治疗小儿急性病毒性心肌炎的疗效观察. 临床合理用药杂志, 2015, 8(31): 83-84.
22.	Putschoegl A, Auerbach S. Diagnosis, evaluation, and treatment of myocarditis in children. Pediatr Clin North Am, 2020, 67(5): 855-874.
23.	Razzano D, Fallon JT. Myocarditis: somethings old and something new. Cardiovasc Pathol, 2020, 44: 107155.
24.	Fung G, Luo H, Qiu Y, et al. Myocarditis. Circ Res, 2016, 118(3): 496-514.
25.	Schultz JC, Hilliard AA, Cooper LT, et al. Diagnosis and treatment of viral myocarditis. Mayo Clin Proc, 2009, 84(11): 1001-1009.
26.	Lasrado N, Reddy J. An overview of the immune mechanisms of viral myocarditis. Rev Med Virol, 2020, 30(6): 1-14.
27.	Rose NR. Myocarditis: infection versus autoimmunity. J Clin Immunol, 2009, 29(6): 730-737.
28.	Chen WH, Guo YS, Zhang DH, et al. Long-term prognosis of suspected myocarditis and cardiomyopathy associated with viral infection of the myocardial tissue: a meta-analysis of cohort studies. Cardiovasc Ther, 2019, 2019: 9342792.
29.	Liu PP, Mason JW. Advances in the understanding of myocarditis. Circulation, 2001, 104(9): 1076-1082.
30.	Reddy J, Massilamany C, Buskiewicz I, et al. Autoimmunity in viral myocarditis. Curr Opin Rheumatol, 2013, 25(4): 502-508.
31.	Levi D, Alejos J. Diagnosis and treatment of pediatric viral myocarditis. Curr Opin Cardiol, 2001, 16(2): 77-83.

1. Van Linthout S, Tschöpe C. Viral myocarditis: a prime example for endomyocardial biopsy-guided diagnosis and therapy. Curr Opin Cardiol, 2018, 33(3): 325-333.
2. Verma V, Sondhi S, Sharma R, et al. COVID-19 associated viral myocarditis: does it exist? Monaldi Arch Chest Dis, 2020, 90(4): 561-562.
3. Rezkalla SH, Kloner RA. Viral myocarditis: 1917-2020: from the influenza A to the COVID-19 pandemics. Trends Cardiovasc Med, 2021, 31(3): 163-169.
4. Lv S, Rong J, Ren S, et al. Epidemiology and diagnosis of viral myocarditis. Hellenic J Cardiol, 2013, 54(5): 382-391.
5. Olejniczak M, Schwartz M, Webber E, et al. Viral myocarditis-incidence, diagnosis and management. J Cardiothorac Vasc Anesth, 2020, 34(6): 1591-1601.
6. Pollack A, Kontorovich AR, Fuster V, et al. Viral myocarditis-diagnosis, treatment options, and current controversies. Nat Rev Cardiol, 2015, 12(11): 670-680.
7. Shauer A, Gotsman I, Keren A, et al. Acute viral myocarditis: current concepts in diagnosis and treatment. Isr Med Assoc J, 2013, 15(3): 180-185.
8. Narovlyanskaya O, Winokur EJ. Viral myocarditis. Dimens Crit Care Nurs, 2020, 39(2): 75-80.
9. 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.
10. 王薇. 静注丙种球蛋白联合糖皮质激素治疗急性重症病毒性心肌炎的临床研究. 青岛: 青岛大学, 2017.
11. 石志玲, 向敏. 参麦注射液联合地塞米松治疗病毒性心肌炎的临床研究. 现代药物与临床, 2018, 33(6): 1366-1370.
12. 杨德彬. 利巴韦林联合地塞米松治疗小儿急性病毒性心肌炎临床效果观察. 中国实用医药, 2015, (6): 153-154.
13. Chen HS, Wang W, Wu SN, et al. Corticosteroids for viral myocarditis. Cochrane Database Syst Rev, 2013, (10): CD004471.
14. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. Cochrane, 2021. Available at: www.training.cochrane.org/handbook.
15. 令狐克强. 试析地塞米松在治疗病毒性心肌炎的临床疗效. 医药前沿, 2017, 7(13): 161.
16. 侯世敬. 小剂量地塞米松治疗心肌炎的效果及不良反应评价. 世界最新医学信息文摘(连续型电子期刊), 2016, 16(78): 102-102.
17. 张金霞, 宫临征. 地塞米松在治疗病毒性心肌炎的临床疗效分析. 中国继续医学教育, 2015, 7(13): 163-164.
18. 张颖芳. 利巴韦林、大剂量维生素 C 及地塞米松治疗小儿急性病毒性心肌炎的效果探析. 当代医药论丛, 2017, 15(3): 35-36.
19. 徐常娟, 任燕. 分析地塞米松在治疗病毒性心肌炎中的临床疗效. 世界最新医学信息文摘(连续型电子期刊), 2018, 18(A1): 39-40.
20. 苗春娇. 地塞米松在治疗病毒性心肌炎中的临床疗效评价. 中国现代药物应用, 2019, 13(22): 138-139.
21. 陈敏, 陈淑红, 侯林涛, 等. 大剂量维生素 C 辅助利巴韦林与地塞米松治疗小儿急性病毒性心肌炎的疗效观察. 临床合理用药杂志, 2015, 8(31): 83-84.
22. Putschoegl A, Auerbach S. Diagnosis, evaluation, and treatment of myocarditis in children. Pediatr Clin North Am, 2020, 67(5): 855-874.
23. Razzano D, Fallon JT. Myocarditis: somethings old and something new. Cardiovasc Pathol, 2020, 44: 107155.
24. Fung G, Luo H, Qiu Y, et al. Myocarditis. Circ Res, 2016, 118(3): 496-514.
25. Schultz JC, Hilliard AA, Cooper LT, et al. Diagnosis and treatment of viral myocarditis. Mayo Clin Proc, 2009, 84(11): 1001-1009.
26. Lasrado N, Reddy J. An overview of the immune mechanisms of viral myocarditis. Rev Med Virol, 2020, 30(6): 1-14.
27. Rose NR. Myocarditis: infection versus autoimmunity. J Clin Immunol, 2009, 29(6): 730-737.
28. Chen WH, Guo YS, Zhang DH, et al. Long-term prognosis of suspected myocarditis and cardiomyopathy associated with viral infection of the myocardial tissue: a meta-analysis of cohort studies. Cardiovasc Ther, 2019, 2019: 9342792.
29. Liu PP, Mason JW. Advances in the understanding of myocarditis. Circulation, 2001, 104(9): 1076-1082.
30. Reddy J, Massilamany C, Buskiewicz I, et al. Autoimmunity in viral myocarditis. Curr Opin Rheumatol, 2013, 25(4): 502-508.
31. Levi D, Alejos J. Diagnosis and treatment of pediatric viral myocarditis. Curr Opin Cardiol, 2001, 16(2): 77-83.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of dexamethasone in the treatment of viral myocarditis: a meta-analysis

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