| Abstrakt: |
Background: In Systemic Lupus Erythematosus (SLE), cardiovascular involvement is an important cause of morbidity and mortality, and lupus myocarditis (LM), despite uncommon, is potentially fatal. At present, there is still a lack of evidence concerning the most appropriate therapeutic approach for this manifestation. Objectives: To systematically identify and review avai - lable literature evaluating immunosuppressive (IS) treatment in LM. Methods: A systematic literature search was performed in MEDLINE using the MeSH terms "myocarditis" and "systemic lupus erythematosus". All retrieved articles were screened by title and abstract and the eligible ones were kept for full-text review. Reference lists were additionally searched. Original research papers of LM cohorts encompassing treatment, in patients aged =18 years old, were considered for inclusion. Study quality assessment was performed with the National Institute of Health (NIH) Quality assessment tools. Given the low number of research articles retrieved, case reports were also compiled. Results: The systematic search identified 341 unique search results, of which 231 were excluded after title and abstract screening. After full-text review of the remaining 110, 5 original research papers and 24 case report papers were included. The original research papers were all longitudinal retrospective studies, with samples ranging from 11 to 29 patients (table), only 2 with statistical analysis. Case report papers encom passed 32 LM episodes (table). The most frequent IS was intravenous cyclophosphamide (iv Cyc); the 2 studies that compared this agent versus others (methotrexate, mycophenolate mofetil, steroids, intravenous immunoglobulin (ivIgG)) (1,2) found no differences. Steroid therapy and ivIG were used as adjuvant but also as sole treatment. Despite a few cases of death due to LM (n=10) and LM relapse (n=4), the majority of reports had a benefic outcome and cohort studies showed improvements in left ventricle ejection fraction. Conclusion: The included papers present a high risk of bias, precluding consistent conclusions. Iv Cyc was the most common agent used, but other retrieved options were mycophenolate mofetil, azathioprine, rituximab and methotrexate. Of note, bortezomib and mizoribine were both used in 1 case report each, with positive results. Steroids, ivIG and plasma exchange are adjuvant options to consider when treating LM. [ABSTRACT FROM AUTHOR] |
