Efficacy of antiviral treatment in cytomegalovirus detected ulcerative colitis: meta-analysis of available data

<b>Aim:</b> This meta-analysis aimed to pool available data regarding the efficacy of ganciclovir treatment among cytomegalovirus-detected ulcerative colitis patients. <b>Methods:</b> We screened PubMed, Ovid, Web of Science and Cochrane databases for relevant studies, and four investigators independently evaluated the studies for eligibility. The primary outcome was surgical resection or death from ulcerative colitis. The data were then pooled via DerSimonian–Laird estimator and Mantel–Haenszel (MH) method, two points added for continuity correction and random-effects model fitted in the Bayesian framework. We first constructed a Bugs model with Student <i>t</i>-distribution as prior for between-study heterogeneity. The model was fitted by Gibbs sampler (JAGS) to produce a marginal posterior distribution. <b>Results:</b> Our screening identified 15 eligible studies for final data synthesis and combined data from 191 ganciclovir-treated and 166 non-treated patients. Effect estimates from the fixed-effects meta-analysis model did not encourage ganciclovir treatment (OR, 1.43; 95% CIs [0–95, 2.16]), with a negligible unaccounted heterogeneity (<i>I</i>² = 0%). The Bayesian random-effects model generated high-density credible intervals, suggesting a high probability, that future studies will also not encourage ganciclovir treatment (mu, 1.028; 95% credible intervals [0.054, 2.238]; 80% credible intervals [0.401, 1.703]) which indicates that future studies will favor non-treatment of ulcerative colitis with ganciclovir. <b>Conclusions:</b> Data produced in this study do not encourage ganciclovir treatment for UC patients. However, studies included in this analysis were observational, and thus, inherited severe selection bias. We suggest randomized controlled studies be conducted to make firm recommendations in this context.

**研究目的：** 本荟萃分析（meta-analysis）旨在整合现有数据，评估更昔洛韦（ganciclovir）治疗巨细胞病毒（cytomegalovirus）检测阳性溃疡性结肠炎（ulcerative colitis, UC）患者的临床疗效。
**研究方法：** 本研究检索了PubMed、Ovid、Web of Science及Cochrane数据库中的相关研究，并由4名研究者独立对研究的纳入资格进行评估。本研究的主要结局指标为溃疡性结肠炎相关手术切除或患者死亡。随后采用DerSimonian-Laird估计量与Mantel-Haenszel（MH）法进行数据合并，同时通过连续性校正添加2个校正点，并在贝叶斯框架下拟合随机效应模型。本研究首先构建了以学生t分布（Student t-distribution）作为研究间异质性先验的Bugs模型，该模型通过吉布斯采样器（Gibbs sampler, JAGS）进行拟合，以生成边际后验分布。
**研究结果：** 本次检索共纳入15项符合标准的研究用于最终数据合成，合并样本包括191例接受更昔洛韦治疗的患者与166例未接受治疗的患者。固定效应荟萃分析模型得到的效应量结果不支持更昔洛韦治疗（比值比OR=1.43；95%置信区间CI[0.95, 2.16]，原文原标注为[0–95, 2.16]，推测为笔误修正），未观测到明显的未解释异质性（I²=0%）。贝叶斯随机效应模型生成了高密度可信区间，结果提示未来研究大概率仍不会支持更昔洛韦治疗（均值μ=1.028；95%可信区间[0.054, 2.238]；80%可信区间[0.401, 1.703]），这表明未来研究将倾向于不使用更昔洛韦治疗溃疡性结肠炎。
**研究结论：** 本研究所得数据不支持为溃疡性结肠炎（UC）患者使用更昔洛韦治疗。但本次纳入分析的研究均为观察性研究，因此存在严重的选择偏倚。因此建议开展随机对照研究，以在该领域得出确定性的临床推荐意见。