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Prednisone and azathioprine in patients with inflammatory cardiomyopathy: Systematic review and meta‐analysis

ESC Heart Failure Jul 31, 2020

Timmermans P, Barradas‐Pires A, Ali O, et al. - Given that chronic non‐viral myocarditis can be managed with immune suppression on tops of optimal medical therapy (OMT) for heart failure, utilizing a combination of prednisolone and azathioprine (IPA), but inconsistency in the impacts of immunosuppression treatment has been noted, so, researchers undertook this meta‐analysis to assess, for the first time ever, all available data regarding the impact of this treatment on left ventricular ejection fraction (LVEF) and the combined clinical endpoint of cardiovascular death and/or heart transplantation‐free survival. They analyzed four trials with using IPA vs OMT in this syndrome, comprising 369 patients. They found IPA on top of OMT failed to improve LVEF with significant heterogeneity. On limiting the pooled estimate to the published investigations only, IPA was shown to cause significant LVEF improvement. The intervention did not afford cardiovascular mortality benefit. Overall, evidence supporting functional as well as prognostic advantages of IPA added to OMT in virus negative inflammatory positive cardiomyopathy is insufficient, at the moment.

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