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

作者：Kopylov Uri^*; Eliakim Raz Noa; Szilagy Andrew; Seidman Ernest; Ben Horin Shomron; Katz Lior

来源：World Journal of Gastroenterology, 2014, 20(10): 2695-2703.

DOI：10.3748/wjg.v20.i10.2695

• Ulcerative colitis
• cytomegalovirus
• colectomy
• antiviral treatment
• gancyclovir
• foscarnet

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 case-control 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 evaluated 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; I-2 = 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; I-2 = 56.9%). Analysis of long-term colectomy rates was possible for 6 studies including 110 patients. No statistically significant difference was found between the treated and untreated groups (OR = 1.71; 95% CI: 0.71-4.13; 6 studies, I-2 = 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.

• 出版日期2014-3-14