Meta-Analysis
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World J Gastroenterol. Mar 14, 2014; 20(10): 2695-2703
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2695
Antiviral therapy in cytomegalovirus-positive ulcerative colitis: A systematic review and meta-analysis
Uri Kopylov, Noa Eliakim-Raz, Andrew Szilagy, Ernest Seidman, Shomron Ben-Horin, Lior Katz
Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel
Uri Kopylov, Ernest Seidman, Division of Gastroenterology, McGill University Health Center, Montreal, Quebec H3G 1A4, Canada
Noa Eliakim-Raz, Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petach Tikva 49100, Israel
Andrew Szilagy, Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada
Uri Kopylov, Shomron Ben-Horin, Lior Katz, Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv 69978, Israel
Author contributions: Kopylov U designed the study, collected the data, and drafted the manuscript; Eliakim-Raz N and Katz L collected and analyzed the data; Szilagy A, Seidman EG and Ben-Horin S designed the study and reviewed the manuscript.
Correspondence to: Dr. Uri Kopylov, Division of Gastroenterology, McGill University Health Center, Montreal, 1650 Cedar Avenue, Quebec H3G 1A4, Canada. ukopylov@gmail.com
Telephone: +1-514-3779356 Fax: +1-514-9348321
Received: August 30, 2013
Revised: December 22, 2013
Accepted: January 8, 2014
Published online: March 14, 2014
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: Ulcerative colitis, Cytomegalovirus, Colectomy, Antiviral treatment, Gancyclovir, Foscarnet

Core tip: We have undertaken a meta-analysis of the existing literature in order to evaluate the impact of antiviral therapy on the outcome (colectomy rate) of ulcerative colitis patients with documented presence of cytomegalovirus. Nine studies of low to moderate quality with significant heterogeneity were included. Patients treated with antivirals did not have a better outcome in comparison to those who were not. These results should be interpreted with caution in view of low quality of the included studies and several potential biases. Additional high-quality studies are required to define the optimal diagnostic and therapeutic strategy for these patients.