IVIg lowers mortality in children with myocarditis

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Key takeaways:

  • Of more than 3,500 children with myocarditis, 6% died and 14% required ECMO support.
  • IVIg with or without steroids was associated with decreased mortality compared with steroid use alone.

TORONTO — Use of IV immunoglobulin with or without steroids was associated with reduced mortality among children with myocarditis compared with steroids alone, according to a study presented at the Pediatric Academic Societies Meeting.

“We had the opportunity to answer a question that I don’t think has been well answered so far, and that is, What medications are going to be helpful in the treatment of acute myocarditis?” Istvan F. Kanyo, MD, a resident physician at Weill Cornell Medicine and co-author of the study, told Healio.

While much has been written about myocarditis and its effects on children, Kanyo said, what was lacking in some of those studies was a large number of patients as part of a randomized controlled trial.

“We thought it would be beneficial to include a large number of patients from a retrospective database, and the database we used was able to accommodate that,” Kanyo said.

Kanyo and colleagues obtained data from the Pediatric Health Information System database on 3,511 patients (median age, 12 years; 65% boys) aged younger than 18 years from 52 hospitals (median length of stay, seven days; interquartile range, three-18). In the cohort, 6% of children died and 14% required support by extracorporeal membrane oxygenation, or ECMO.

The researchers also had pharmacy data for 2,361 patients, and placed them into four groups: no steroids or IV immunoglobulin (IVIg; n = 489), steroids (n = 307), IVIg (n = 996) and both IVIg and steroids (n = 569).

After adjusting for sex, age, race, hospital region, length of stay, need for ICU admission, and presence of a complex chronic condition, Kanyo and colleagues found that receipt of IVIg (adjusted OR = 0.46; 95% CI 0.29-0.73) or the combination of IVIg and steroids (aOR = 0.49, 95% CI 0.329-0.83) were both independently associated with a decrease in mortality vs. steroid use alone.

“I think we were surprised by the overall trend towards improvement with IVIg,” Kanyo told Healio. “I think there is still more work to be done in order to confirm that, and in order to derive any practice guidelines that can really help guide physicians.”

Kanyo said every patient must be considered on a case-by-case basis.

“I do think that it is worth considering that our use of IVIg for the management of myocarditis seems to be trending down over time,” Kanyo said. “But at least with our study results, in the right patient, it could certainly be helpful in reducing mortality or ECMO cannulation.”

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