title: Antiviral therapy in cytomegalovirus-positive ulcerative colitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.affiliation: Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Eliakim-Raz
authors.affiliation: Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel.
authors.forename: Andrew
authors.initials: A
authors.lastname: Szilagy
authors.affiliation: Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel.
authors.forename: Ernest
authors.initials: E
authors.lastname: Seidman
authors.affiliation: Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel.
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.affiliation: Uri Kopylov, Shomron Ben-Horin, Lior Katz, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Katz
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003106:Colon / Q000187:drug effects* / Q000601:surgery* / Q000821:virology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: Antiviral treatment; Colectomy; Cytomegalovirus; Foscarnet; Gancyclovir; Ulcerative colitis