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MYTHS-MR Trial (MYocarditis THerapy With Steroids in Patients With Mildly Reduced Ejection Fraction) (MYTHS-MR)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT05974462
Recruitment Status : Recruiting
First Posted : August 3, 2023
Last Update Posted : June 7, 2024
Niguarda Hospital
Information provided by (Responsible Party):
University Hospital, Antwerp

Brief Summary:

The goal of this clinical trial is to demonstrate the efficacy of pulsed intravenous methylprednisolone in a single-blind randomized controlled trial versus standard therapy in patients with acute myocarditis and a mildly reduced LVEF.

The main question[s] it aims to answer are:

  • is there an increase in LVEF (≥55% or an absolute increase in LVEF ≥ 10%) on echocardiogram after 5 days from randomization in patients treated with pulsed corticosteroid therapy vs. standard therapy?
  • is there a reduction in the proportion of patients with LVEF < 55% AND/OR LV dilation on a 6-month CMRI in patients treated pulsed corticosteroid therapy vs. standard therapy?
  • To assess the effect of corticosteroids on the occurrence of the combined endpoint(1) all-cause death or (2) HTx or (3) long-term LVAD implant or (4) first rehospitalization due to HF or ventricular arrhythmias, or advanced AV block.

Participants will be randomized in two arms in a 1:1 ratio. The experimental group will receive pulsed corticosteroid therapy on top of the standard therapy and patients in the placebo group will be treated with a saline solution on top of their standard therapy. All other tests are executed according to standard of care.

Condition or disease Intervention/treatment Phase
Acute Myocarditis Drug: Methylprednisolone 125 MG Other: IV saline solution 0.9% Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 174 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Single Blind, Investigator-initiated, Randomized Controlled Trial
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: Single-blind, Investigator-initiated, Randomized, Controlled Trial to Assess the Safety and Efficacy of Intravenous Corticosteroid Therapy to Treat Patients With Acute Myocarditis With Mildly Reduced Left Ventricular Ejection Fraction
Actual Study Start Date : May 24, 2024
Estimated Primary Completion Date : October 1, 2026
Estimated Study Completion Date : October 1, 2028

Arm Intervention/treatment
Experimental: Pulsed corticosteroid therapy
IV methylprednisolone 125 mg daily for 3 days diluted in saline solution 250 ml on top of standard therapy.
Drug: Methylprednisolone 125 MG
125 mg daily for 3 days diluted in saline solution 250 mL
Other Name: Solu-Medrol

Placebo Comparator: Placebo
IV saline solution 250 mL daily for 3 days on top of standard therapy.
Other: IV saline solution 0.9%
Saline solution 0.9% 250 mL
Other Name: sodium chloride

Primary Outcome Measures :
  1. Left ventricular ejection fraction [ Time Frame: Day 5 ]
    LVEF ≥55% or an absolute increase in LVEF≥10% on echocardiogram after 5 days from randomization (echocardiographic clips will be centrally reviewed in a blind fashion by readers).

Secondary Outcome Measures :
  1. Improvement of the composite endpoint [ Time Frame: 6 months ]
    Proportion of patients with LVEF<55% AND/OR LV dilation on 6-month cardiac magnetic resonance imaging (CMRI) (CMRI clips will be centrally reviewed in a blind fashion by readers)

  2. Composite endpoint defined as the time from randomization to the first event [ Time Frame: Within 6 months and 2 years ]
    among: (1) all-cause death or (2) HTx or (3) long-term LVAD implant or (4) first rehospitalization due to HF or ventricular arrhythmias, or advanced AV block.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 69 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • LVEF<50% and LV-EDD<56 mm (parasternal long-axis view) on echocardiogram;
  • Increased troponin (3x URL) at the time of randomization;
  • Clinical onset of cardiac symptoms within 3 weeks from randomization;
  • Excluded coronary artery disease by coronary angiogram in subjects ≥46 years of age, in case myocarditis is not histologically proven;
  • Randomization within 120 hours from hospital admission.
  • Endomyocardial biopsy (EMB) is not considered necessary before randomization and performing EMB is based on the decision of the local team.

Exclusion Criteria:

  • Known systemic autoimmune disorder or other conditions at the time of randomization where immunosuppression is assumed useful. Patients in whom a systemic autoimmune disorder will be diagnosed during hospitalization will be included in the study if randomized, including patients with a diagnosis of cardiac sarcoidosis or GCM). Both patients included in the corticosteroids-treatment arm or in the placebo-treatment arm can receive the standard immunosuppressive therapy used in the center since the diagnosis;
  • Patients already on oral/IV chronic corticosteroid therapy or other chronic immunosuppressive therapies (colchicine or nonsteroidal anti-inflammatory drugs [NSAIDs] are not considered immunosuppressive drugs);
  • Contraindication to corticosteroids, including allergies to this medication and its excipients;
  • Patients with persistent peripheral eosinophilia (persistent eosinophil count >7% of the leukocytes) or known hypereosinophilic syndrome at the time of randomization. Patients in whom eosinophilic myocarditis will be diagnosed on EMB will be included in the study if already randomized. Both patients included in the corticosteroids-treatment arm or in the placebo-treatment arm can receive the standard immunosuppressive therapy used in the center since the diagnosis;
  • Myocarditis associated with the ongoing administration of anti-cancer immune checkpoint inhibitor (ICI) agents;
  • Previously known chronic cardiac (i.e., previous cardiomyopathy, that does NOT include previous myocarditis if there is a functional recovery at the time of screening);
  • Evidence of active bacterial or fungal infectious disease (presence of fever or increased C-reactive protein are not considered exclusion criteria), or suspected bacterial/fungal infection associated with increased levels of procalcitonin (cut-off >10 ng/mL), if the laboratory exam is available in the center;
  • Known chronic infective disease, such as HIV infection or tuberculosis;
  • Out-of-hospital cardiac arrest;
  • Echocardiographic presence of images suggestive of other cardiac diseases (i.e. endocarditis)
  • Participants involved in another clinical trial;
  • Pregnant women (known pregnancy) or POSITIVE human chorionic gonadotropin (HCG) test measures (urine/blood) for women of 18-50 years of age.
  • Any other significant disease with expected life expectancy <12 months (i.e., evidence of irreversible severe brain injury) or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the trial, or may influence the result of the trial, or the participant's ability to participate in the trial.
  • If LVEF<41%, an N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration of 1600 pg/mL or more or a B-type natriuretic peptide (BNP) concentration of 400 pg/mL or more; (if LVEF 41%-<50% any NT-proBNP or BNP concentration is allowed).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT05974462

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Contact: Caroline Van De Heyning, MD PhD +32 821 3538
Contact: Nicole Sturkenboom, MD +32 821 3538

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Antwerp University Hospital Recruiting
Edegem, Antwerp, Belgium
Contact: Caroline Van De Heyning         
Onze-Lieve-Vrouwziekenhuis (OLV ziekenhuis) Recruiting
Aalst, Belgium
Contact: Ward Heggermont         
Middelheim Ziekenhuis Not yet recruiting
Antwerpen, Belgium
Contact: Gaëlle Vermeersch         
Jessa ziekenhuis Recruiting
Hasselt, Belgium
Contact: Philippe Timmermans         
Azienda USL Toscane SUD Est Not yet recruiting
Arezzo, Italy
Contact: Maurizio Pieroni         
Azienda Ospedaliera Papa Giovanni XXIII Not yet recruiting
Bergamo, Italy
Contact: Aurelia Grosu         
ASST Spedali Civili di Brescia Not yet recruiting
Brescia, Italy, 25123
Contact: Daniela Tomasoni         
Careggi University Hospital Not yet recruiting
Firenze, Italy
Contact: Francesco Cappelli         
Alessandro Manzoni hospital Not yet recruiting
Lecco, Italy, 23900
Contact: Roberto Spoladore         
Ospedale Maggiore di Milano Not yet recruiting
Milano, Italy
Contact: Margherita Calcagnino         
Niguarda Hospital Not yet recruiting
Milan, Italy, 20125
Contact: Enrico Ammirati, MD PhD         
Fondazione IRCCS Policlinico San Matteo Not yet recruiting
Pavia, Italy
Contact: Rossana Totaro         
Fondazione Toscana Gabriele Monasterio Not yet recruiting
Pisa, Italy
Contact: Michele Emdin         
Policlinico Universitario Agostino Gemelli Not yet recruiting
Roma, Italy
Contact: Maria Lucia Narducci         
Azienda Sanitaria Universitaria Friuli Centrale Not yet recruiting
Udine, Italy
Contact: Massimo Imazio         
University Medical Centre of Ljubljana Recruiting
Ljubljana, Slovenia
Contact: Andreja Cerne         
Sponsors and Collaborators
University Hospital, Antwerp
Niguarda Hospital
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Principal Investigator: Caroline Van de Heyning University Hospital, Antwerp
Study Chair: Enrico Ammirati Niguarda Hospital Milano
Study Chair: Nicole Sturkenboom University Hospital, Antwerp

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Responsible Party: University Hospital, Antwerp Identifier: NCT05974462    
Other Study ID Numbers: 2022-501547-33-00
First Posted: August 3, 2023    Key Record Dates
Last Update Posted: June 7, 2024
Last Verified: June 2023

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Heart Diseases
Cardiovascular Diseases
Methylprednisolone Acetate
Methylprednisolone Hemisuccinate
Prednisolone acetate
Prednisolone hemisuccinate
Prednisolone phosphate
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Neuroprotective Agents
Protective Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents