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Antiviral therapy may lower colectomy risk in steroid-refractory UC patients with cytomegalovirus
Low quality evidence from a systematic review and meta-analysis suggested antiviral therapy may lower risk for colectomy in steroid-refractory ulcerative colitis patients with cytomegalovirus.
“The role of [cytomegalovirus] in ulcerative colitis exacerbations remains unclear and has been a topic of great debate for decades,” Jeffrey McCurdy, MD, PhD, from the division of gastroenterology and hepatology at The Ottawa Hospital in Canada, told Healio Gastroenterology. “A necessary clue to aid in resolving this debate is to understand the impact of anti-viral therapy.”
Jeffrey McCurdy
To evaluate the effect of antiviral therapy on colectomy rate in UC patients with cytomegalovirus, McCurdy and colleagues searched relevant cohort, case-control and case series studies with at least five patients and identified 15 published between 1999 and 2014. The studies included a total of 333 patients, 43.2% of whom were treated with antiviral therapy, and the majority of whom had moderate to severe UC.
Overall quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, and the primary outcome was colectomy risk for patients with cytomegalovirus treated with and without antiviral therapy, for the UC population overall and for steroid-refractory patients.
The researchers found colectomy risk was significantly reduced in steroid-refractory UC patients who underwent antiviral therapy compared with those who were not (OR = 0.2; 95% CI, 0.08-0.49), but not in the overall UC population (OR = 0.92; 95% CI, 0.31-2.76). The result remained significant when analysis was restricted to patients with a tissue diagnosis of cytomegalovirus (OR = 0.17; 95% CI, 0.06-0.48), to those who were diagnosed before colectomy (OR = 0.24; 95% CI, 0.07-0.75), or to those whose refractory disease was defined as no response to 1 week of intravenous corticosteroids (OR = 0.23; 95% CI, 0.06-0.82).
Colectomy risk was also found to be lower only among patients whose cytomegalovirus was diagnosed based on hematoxylin and eosin staining or immunohistochemistry (OR = 0.06; 95% CI, 0.01-0.34) compared with those who were diagnosed by tissue polymerase chain reaction (OR = 0.31; 95% CI, 0.09-1.11). The quality of evidence for using antiviral therapy to reduce colectomy risk in steroid-refractory UC patients with cytomegalovirus was deemed low based on the limitations of observational study designs and risk of bias.
“We demonstrated two key findings: 1) Not all UC patients with [cytomegalovirus] require antiviral therapy and 2) UC patients with corticosteroid-refractory disease appear to benefit from antiviral therapy,” McCurdy said. “The quality of evidence however supporting these findings was low, driven largely by the lack of randomized controlled trials.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
Editor’s Note: This article was updated on August 5 to reflect additional information.