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

Abstract

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; 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 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, 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.

Keywords: Antiviral treatment; Colectomy; Cytomegalovirus; Foscarnet; Gancyclovir; Ulcerative colitis.

Figure 1

Selection of studies on cytomegalovirus infection complicating ulcerative colitis.

Figure 2

Colectomy rate in cytomegalovirus infection complicating ulcerative colitis. A: The rate of colectomy during hospitalization tended to be lower among the patients who did not receive antiviral treatment; B: No significant difference was found in the rate of colectomy during follow-up period.

Figure 3

Cytomegalovirus demonstrated on a colonic biopsy in a patient with ulcerative colitis (arrows). A: Hematoxylin eosin staining; B: Immunohistochemistry, adapted from [16].

Figure 4

Proposed algorithm for decision on initiation of antiviral therapy in a ulcerative colitis patient with histological evidence of cytomegalovirus in the colonic mucosa. ¹Unclear whether antiviral treatment should be tapered/stopped. UC: Ulcerative colitis; HE: Hematoxylin-eosin staining; IHC: Immunohistochemistry; CMV: Cytomegalovirus.