Immunosuppressive treatment for inflammatory cardiomyopathy: meta-analysis of randomized controlled trials

The use of immunosuppressive therapy for inflammatory cardiomyopathy is controversial. The aim of this review is to summarize the current empirical evidence for immunosuppressive treatment in inflammatory cardiomyopathy. We conducted a meta-analysis of all randomized controlled trials (RCTs) that compared immunosuppressive therapy with either placebo or conventional treatment in patients with inflammatory cardiomyopathy. The pooled outcomes were all-cause death and heart transplantation for inflammatory cardiomyopathy, left ventricular ejection fraction (LVEF), and left ventricular end diastolic dimension (LVEDD). Five trials involving 316 patients were included. Overall, immunosuppressive therapy was not superior to placebo and conventional therapy in the pooled outcome of all-cause death and heart transplantation (odds ratio [OR] 1.03, 95% confidence intervals [CI] 0.58 to 1.80) in the long-term. The pooled data showed that there might be a short-term beneficial effect on LVEF improvement (5.06%, 95% CI -0.07% to 10.18%) in patients receiving immunosuppressive therapy, but no beneficial effect on LVEDD either in the short-term (-0.87 mm; 95% CI, -8.29 to 6.55 in adult patients) or long-term (-0.52 mm, 95% CI -3.64 to 2.60 in adult patients) was observed. There is no evidence to suggest that immunosuppressive therapy has an effect on improving the survival of patients with inflammatory cardiomyopathy. Current therapy in inflammatory cardiomyopathy seems to be limited to supportive measures or transplantation.