Abstract
Background: Previous animal studies reported an association of non-steroidal anti-inflammatory drugs (NSAIDs) with adverse outcomes in acute myocarditis, which is why these drugs are currently not recommended in affected patients. In this retrospective case-control study, we sought to investigate the effects of NSAID treatment in patients with acute myocarditis and myopericarditis to complement the available evidence. Method: A total of 114 patients with acute myocarditis were retrospectively enrolled. Demographical, clinical and laboratory data were extracted from hospital records. Patients who received NSAIDs (n = 39, 34.2%) were compared to controls. Follow-up on all-cause mortality was acquired for two years. Propensity score matching was additionally conducted to account for covariate imbalances between groups. Results: Treatment with NSAIDs was neither associated with a worse outcome (p = 0.115) nor with significant differences in left ventricular systolic function (p = 0.228) or in-hospital complications (p = 0.507). Conclusion: Treatment with NSAIDs was not associated with adverse outcomes in our study cohort. Together with the findings of previous studies, our results indicate that these drugs could be safely administered in patients with myocarditis and myopericarditis.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid and ibuprofen constitute a cornerstone in the treatment of acute pericarditis, where they have proven effective in ameliorating symptoms and reducing inflammation [1,2,3,4]
Similar findings were reported by Khatib et al, who found that treatment with indomethacin increases titers of coxsackisevirus B4 in a mouse model of acute myocarditis [8], and by Rezkalla et al, who reported increased mortality, elevated viral titers and reduced concentrations of interferon in animals treated with non-steroidal anti-inflammatory drugs (NSAIDs) [9]
With a class IA recommendation in the current European Society of Cardiology (ESC) guidelines [13], NSAIDs represent the mainstay of therapy in patients with acute pericarditis and should be administered in full doses to all affected patients until symptom resolution [17]
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid and ibuprofen constitute a cornerstone in the treatment of acute pericarditis, where they have proven effective in ameliorating symptoms and reducing inflammation [1,2,3,4]. In contrast to acute pericarditis, treatment with NSAIDs is currently not recommended in patients with acute myocarditis [5] because of the findings of previous animal studies that suggested deleterious effects of these drugs on disease progression [5,6]. Previous animal studies reported an association of non-steroidal anti-inflammatory drugs (NSAIDs) with adverse outcomes in acute myocarditis, which is why these drugs are currently not recommended in affected patients. In this retrospective case-control study, we sought to investigate the effects of NSAID treatment in patients with acute myocarditis and myopericarditis to complement the available evidence. Together with the findings of previous studies, our results indicate that these drugs could be safely administered in patients with myocarditis and myopericarditis
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