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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8.	Narovlyanskaya O, Winokur EJ. Viral myocarditis. Dimens Crit Care Nurs, 2020, 39(2): 75-80.
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17.	張金霞, 宮臨征. 地塞米松在治療病毒性心肌炎的臨床療效分析. 中國繼續醫學教育, 2015, 7(13): 163-164.
18.	張穎芳. 利巴韋林、大劑量維生素 C 及地塞米松治療小兒急性病毒性心肌炎的效果探析. 當代醫藥論叢, 2017, 15(3): 35-36.
19.	徐常娟, 任燕. 分析地塞米松在治療病毒性心肌炎中的臨床療效. 世界最新醫學信息文摘(連續型電子期刊), 2018, 18(A1): 39-40.
20.	苗春嬌. 地塞米松在治療病毒性心肌炎中的臨床療效評價. 中國現代藥物應用, 2019, 13(22): 138-139.
21.	陳敏, 陳淑紅, 侯林濤, 等. 大劑量維生素 C 輔助利巴韋林與地塞米松治療小兒急性病毒性心肌炎的療效觀察. 臨床合理用藥雜志, 2015, 8(31): 83-84.
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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, Tsch?pe 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. 靜注丙種球蛋白聯合糖皮質激素治療急性重癥病毒性心肌炎的臨床研究. 青島: 青島大學, 2017.
11. 石志玲, 向敏. 參麥注射液聯合地塞米松治療病毒性心肌炎的臨床研究. 現代藥物與臨床, 2018, 33(6): 1366-1370.
12. 楊德彬. 利巴韋林聯合地塞米松治療小兒急性病毒性心肌炎臨床效果觀察. 中國實用醫藥, 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. 令狐克強. 試析地塞米松在治療病毒性心肌炎的臨床療效. 醫藥前沿, 2017, 7(13): 161.
16. 侯世敬. 小劑量地塞米松治療心肌炎的效果及不良反應評價. 世界最新醫學信息文摘(連續型電子期刊), 2016, 16(78): 102-102.
17. 張金霞, 宮臨征. 地塞米松在治療病毒性心肌炎的臨床療效分析. 中國繼續醫學教育, 2015, 7(13): 163-164.
18. 張穎芳. 利巴韋林、大劑量維生素 C 及地塞米松治療小兒急性病毒性心肌炎的效果探析. 當代醫藥論叢, 2017, 15(3): 35-36.
19. 徐常娟, 任燕. 分析地塞米松在治療病毒性心肌炎中的臨床療效. 世界最新醫學信息文摘(連續型電子期刊), 2018, 18(A1): 39-40.
20. 苗春嬌. 地塞米松在治療病毒性心肌炎中的臨床療效評價. 中國現代藥物應用, 2019, 13(22): 138-139.
21. 陳敏, 陳淑紅, 侯林濤, 等. 大劑量維生素 C 輔助利巴韋林與地塞米松治療小兒急性病毒性心肌炎的療效觀察. 臨床合理用藥雜志, 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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