The treatment of rheumatic carditis: a review and meta-analysis.
We performed a meta-analysis of the literature on the treatment of established rheumatic carditis to determine if corticosteroid therapy is superior to salicylates in preventing the sequela of inflammation--valvular damage. We identified 22 reports of comparative trials published since the introduction of corticosteroids in 1949. Five of the 22 studies met the criteria we established for the meta-analysis, which included using randomization and a 1-year follow-up for the presence of a new pathologic apical systolic murmur. Based on the meta-analysis, the advantage of corticosteroid treatment over salicylates in preventing a pathologic murmur at 1 year posttreatment is not statistically significant (estimated odds ratio 0.88; 95% confidence interval: 0.53 to 1.46). However, the meta-analysis is dominated by 1 large negative trial, and there was significant heterogeneity in the results obtained from the studies in the meta-analysis; thus, the question of whether corticosteroid therapy is marginally superior to salicylates for the prevention of valvular heart disease from rheumatic fever remains open.
Department of Medicine, University of Chicago, Illinois 60637.
D A
DA
Albert
L
L
Harel
T
T
Karrison
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D006801:Humans; D009205:Myocarditis / Q000188:drug therapy* / Q000209:etiology; D012214:Rheumatic Heart Disease / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones; D001241:Aspirin