Corticosteroids for viral myocarditis

Abstract

Background Myocarditis is an uncommon heart disease. There is experimental evidence showing that autoimmune mechanisms follow viral infection, resulting in inflammation and necrosis in myocardium. However, the use of corticosteroids as immunosuppressives in this condition remains controversial. Objectives To assess the beneficial and harmful effects of treating viral myocarditis with corticosteroids. Search methods Trials were identified by searching The Cochrane Heart Group Register ( to April 2004), the Cochrane Library (Issue 4, 2003), and MEDLINE, EMBASE, BIOSIS for meeting abstracts, LILACS, and Chinese Biomedical CD Database from their date of inception to April 20, 2004. Four Chinese medical journals were handsearched. A total of 507 articles were found but none of them was eligible to be included in our review. Selection criteria Randomised controlled trials of corticosteroids for viral myocarditis compared with no intervention, placebo, supportive therapy, antiviral agents therapy or conventional therapy, including trials of corticosteroids plus other treatment versus other treatment alone, irrespective of blinding, publication status, or language. Data collection and analysis Two reviewers extracted data independently. We asked authors of trials to provide information when diagnosis or methodology was unclear or data were incomplete. Results were presented as risk ratios (RR) and weighted mean differences (WMD), both with 95% confidence intervals (CI). Main results No randomised controlled trials of corticosteroids for viral myocarditis were found that met our inclusion criteria. Authors' conclusions There is no randomised evidence to support the use of corticosteroids for viral myocarditis. Further clinical trials are needed.