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Background <p>Therapeutic benefits of intravenous immunoglobulin (IVIG) and steroids remain inconclusive in optimizing treatment strategies for acute myocarditis.</p> Methods <p>PubMed, EMBASE, Cochrane databases, and Web of Science were searched for studies evaluating the effectiveness of adjunctive IVIG, steroids, or both with standard heart failure treatment in pediatric acute myocarditis. A random-effects network meta-analysis was conducted using frequentist and Bayesian approaches. Effect sizes were calculated as risk ratio (RR) and mean difference (MD). P-scores provided a ranking of treatments.</p> Results <p>Thirteen studies comprising 2850 participants were involved. Compared with standard treatment, IVIG reduced in-hospital mortality (RR, 0.52; 95% CI, 0.35–0.76), long-term mortality (RR, 0.5; 95% CI, 0.27–0.98), overall mortality (RR, 0.52; 95% CI, 0.34–0.76), and better composite outcome (RR, 0.61; 95% CI, 0.43–0.88). IVIG was optimal for reducing in-hospital and overall mortality and improving the composite outcome (P-scores = 0.993, 0.999, 0.986). Steroids or their combination with IVIG showed no significant benefit. IVIG improved cardiac function by increasing left ventricular ejection fraction (MD, 6.00%; 95% CI, 0.94–11.06) and reducing left ventricular end-diastolic diameter (MD, −3.77; 95% CI, −7.02 to −0.52).</p> Conclusions <p>Integrating IVIG into standard treatment may significantly enhance outcomes in children with complicated acute myocarditis.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This systematic review and network meta-analysis addresses the gap between clinical trial efficacy and real-world effectiveness in pediatric clinical practice.</p> </ItemContent> <ItemContent> <p>This study suggests that adding IVIG to standard heart failure therapy may improve survival and cardiac function in children with acute complicated myocarditis. The routine use of steroids requires the cautious clinical application.</p> </ItemContent> <ItemContent> <p>High-quality randomized controlled trials are needed to inform guidelines and optimize therapy.</p> </ItemContent> </UnorderedList></p>

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Effect of intravenous immunoglobulin and steroids in acute myocarditis in children: a systematic review and network meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月10日

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  • Thi Bao Trang Thai,
  • Yi-No Kang,
  • Hung Song Nguyen,
  • Khoi Van Tran,
  • Hoi Huu Vo,
  • Phuc Huu Phan,
  • Shih-Yen Chen,
  • El-Wui Loh,
  • Ka-Wai Tam

摘要

Background

Therapeutic benefits of intravenous immunoglobulin (IVIG) and steroids remain inconclusive in optimizing treatment strategies for acute myocarditis.

Methods

PubMed, EMBASE, Cochrane databases, and Web of Science were searched for studies evaluating the effectiveness of adjunctive IVIG, steroids, or both with standard heart failure treatment in pediatric acute myocarditis. A random-effects network meta-analysis was conducted using frequentist and Bayesian approaches. Effect sizes were calculated as risk ratio (RR) and mean difference (MD). P-scores provided a ranking of treatments.

Results

Thirteen studies comprising 2850 participants were involved. Compared with standard treatment, IVIG reduced in-hospital mortality (RR, 0.52; 95% CI, 0.35–0.76), long-term mortality (RR, 0.5; 95% CI, 0.27–0.98), overall mortality (RR, 0.52; 95% CI, 0.34–0.76), and better composite outcome (RR, 0.61; 95% CI, 0.43–0.88). IVIG was optimal for reducing in-hospital and overall mortality and improving the composite outcome (P-scores = 0.993, 0.999, 0.986). Steroids or their combination with IVIG showed no significant benefit. IVIG improved cardiac function by increasing left ventricular ejection fraction (MD, 6.00%; 95% CI, 0.94–11.06) and reducing left ventricular end-diastolic diameter (MD, −3.77; 95% CI, −7.02 to −0.52).

Conclusions

Integrating IVIG into standard treatment may significantly enhance outcomes in children with complicated acute myocarditis.

Impact

This systematic review and network meta-analysis addresses the gap between clinical trial efficacy and real-world effectiveness in pediatric clinical practice.

This study suggests that adding IVIG to standard heart failure therapy may improve survival and cardiac function in children with acute complicated myocarditis. The routine use of steroids requires the cautious clinical application.

High-quality randomized controlled trials are needed to inform guidelines and optimize therapy.