Interferon-β-1b and Corticoids Improve Cardiac Function of Patients with Severe Chronic Parvovirus B19 Myocarditis—A Case Series

Background: An increase in severe chronic parvovirus B19 (PVB19) myocarditis cases challenges previous guideline-recommended treatment strategies. Immunomodulation with interferon-β 1b (IFNb1b) with or without corticosteroids has been used in the past as an alternative treatment option. Here, we report a case series of four patients treated with IFNb1b and corticoids as an individual healing attempt.

Methods: Four biopsy-confirmed PVB19 myocarditis patients with severe left ventricular (LV)-dilated cardiomyopathy (DCM; median age 2 years, all female) and refractory course under standard medication were treated with a combination of IFNb1b and corticoids. Prior to immunomodulatory therapy, median LV ejection fraction (LVEF) was 34% (IQR: 25.4–43.8%); median LV end-diastolic diameter (LVIDd) was 3.7 z (IQR: 0.5–5.7 z). Further, persistently high sensitive troponin I (hsTI) levels were found in three patients. Median proBNP was 14,964 ng/L (IQR: 3,997–24,686 ng/L). One patient underwent 2 weeks of treatment with venoarterial extracorporeal membrane oxygenation. All patients received at least one cycle of levosimendan, continuous or recurrent inotropic treatment with milrinone, and guideline-based medical treatment for heart failure. All received intravenous immunoglobulins. According to a recently published protocol, all four patients received IFNb1b, corticoids, and nonsteroidal anti-inflammatory drugs (NSAIDs; Esmel-Vilomera et al, 2022). We developed a checklist to collect standardized laboratory values (including hsTI, proBNP, creatinine, transaminases, and viral load) and monitored cardiac function.

Results: A rapid and continuous normalization of hsTI (IQR: 1–7 days) was found in three patients, while a slower but steady decline was detected in one patient. Within a median of 14 days (IQR: 7–16 days), inotropics could finally be weaned. ProBNP declined by a median of 77.5% (IQR: 59.8–92.9%) and LVEF increased by a median of 1.3 times (IQR: 1.2–1.5) within 4 weeks, whereas LV dilatation remained stable (median LVIDd 3.7 z vs. 3.8 z). On electrocardiography, we recorded a median 1.5-fold increase in total voltage (IQR: 1.3–1.9). No serious adverse events and no PVB19 reactivation in the blood occurred.

Conclusion: We conclude that immunomodulation with IFNb1b in combination with corticoids and NSAID could reduce myocardial inflammation and improve cardiac function in our cohort. This strategy may be a promising treatment option in chronic, CrP-negative, T cell-dominated PVB19 myocarditis.

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Artikel online veröffentlicht:
11. Februar 2025