TY - JOUR
T1 - Effect of intravenous immunoglobulin and steroids in acute myocarditis in children
T2 - a systematic review and network meta-analysis
AU - Thai, Thi Bao Trang
AU - Kang, Yi No
AU - Nguyen, Hung Song
AU - Van Tran, Khoi
AU - Vo, Hoi Huu
AU - Phan, Phuc Huu
AU - Chen, Shih Yen
AU - Loh, El Wui
AU - Tam, Ka Wai
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc 2026.
PY - 2026
Y1 - 2026
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105029766238
UR - https://www.scopus.com/pages/publications/105029766238#tab=citedBy
U2 - 10.1038/s41390-025-04655-0
DO - 10.1038/s41390-025-04655-0
M3 - Review article
AN - SCOPUS:105029766238
SN - 0031-3998
JO - Pediatric Research
JF - Pediatric Research
ER -