Antiviral therapy in cytomegalovirus-positive ulcerative colitis:A systematic review and meta-analysis

• Published in: World journal of gastroenterology : WJG 2014-03, Vol.20 (10), p.2695-2703
• Main Authors: Kopylov, Uri, Eliakim-Raz, Noa, Szilagy, Andrew, Seidman, Ernest, Ben-Horin, Shomron, Katz, Lior
• Format: Article
• Language: English
• Subjects: Antiv; Antiviral Agents - therapeutic use; Chi-Square Distribution; Colectomy; colitis; Colitis, Ulcerative - complications; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - surgery; Colon - drug effects; Colon - surgery; Colon - virology; Cytomegalovirus; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - virology; Humans; Meta-Analysis; Odds Ratio; Risk Factors; Time Factors; Treatment Outcome; Ulcerative
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i10.2695

AIM:To evaluate the impact of antiviral treatment on cytomegalovirus(CMV)-positive ulcerative colitis patients.METHODS:We performed a systematic review and meta-analysis(MA)of comparative cohort and casecontrol studies published between January 1966 and March 2013.Studies focusing on colectomy series and studies including only less than 3 patients in the treated or non-treated arm were excluded.The primary outcome was colectomy within 30 d of diagnosis.Secondary outcomes included colectomy during the follow-up period Subgroup analyses by method of detection of CMV,study design,risk of bias and country of origin were performed.Quality of studies was evalu-ated according to modified New-Castle Ottawa Scale.RESULTS:After full-text review,nine studies with a total of 176 patients were included in our MA.All the included studies were of low to moderate quality.Patients who have received antiviral treatment had a higher risk of 30-d colectomy(OR=2.40;95%CI:1.05-5.50;I2=37.2%).A subgroup analysis including only patients in whom CMV diagnosis was based did not demonstrate a significant difference between the groups(OR=3.41;95%CI:0.39-29.83;I2=56.9%).Analysis of long-term colectomy rates was possible for 6 studies including110 patients.No statistically significant difference was found between the treated and untreated groups(OR=1.71;95%CI:0.71-4.13;6 studies,I2=0%).Analysis of mortality rate was not possible due to a very limited number of cases.Stratification of the outcomes by disease severity was not possible.CONCLUSION:No positive association between antiviral treatment and a favorable outcome was demonstrated.These findings should be interpreted cautiously due to primary studies’quality and potential biases.