title: Antiviral Therapy in Steroid-refractory Ulcerative Colitis with Cytomegalovirus: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  The role of antiviral therapy in patients with ulcerative colitis (UC) with cytomegalovirus (CMV) remains unclear. We therefore performed a systematic review and meta-analysis to assess the association between antiviral therapy and the risk of colectomy.
  
  
  METHODS
  Multiple electronic databases were searched systematically through July 2014 for studies reporting the risk of colectomy in patients with UC with CMV stratified by treatment with antiviral agents. Colectomy rates were assessed for the overall cohort and stratified by corticosteroid (CS) refractoriness. We estimated summary odds ratios and 95% confidence intervals, using random-effects model, and used Grading of Recommendations Assessment, Development, and Evaluation criteria to appraise the quality of evidence.
  
  
  RESULTS
  Fifteen observational studies (333 patients with UC with CMV, 43.2% treated with antiviral agents) were identified, of which 8 stratified patients according to CS-refractory disease (55.4% treated with antiviral agents). Antiviral therapy resulted in a significantly lower risk of colectomy in patients with CS-refractory disease (odds ratio, 0.20; 95% confidence interval, 0.08-0.49; I = 0%) but not in the overall population of patients with UC (odds ratio, 0.92; 95% confidence interval, 0.31-2.76; I = 65). The quality evidence was low. The results were stable when restricting the analysis to patients with a tissue diagnosis of CMV and studies that defined CS-refractory disease as a failure to respond to intravenous CS.
  
  
  CONCLUSIONS
  Antiviral therapy may benefit a subgroup of patients with UC who are refractory to CS. Further prospective trials are required to confirm these findings.
authors.affiliation: *Division of Gastroenterology and Hepatology, The Ottawa Hospital, Ottawa, ON, Canada; and †Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tushar
authors.initials: T
authors.lastname: Shukla
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: McCurdy
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000628:therapy* / Q000821:virology; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy*; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D064887:Observational Studies as Topic; D016017:Odds Ratio
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir