Oral Valganciclovir Monotherapy Versus Sequential Ganciclovir Regimen in Cytomegalovirus Colitis Among IBD Patients: A Retrospective Comparative Study

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Background: Cytomegalovirus (CMV), a herpes virus, is ubiquitous. However, it is in a lifelong dormant state till virus reactivation occurs when the immune system is compromised. The prevalence of latent infection is the same in inflammatory bowel disease (IBD) patients and healthy controls. Reactivation can cause a flare of disease and resistance to the treatment. The preferred antiviral is IV ganciclovir for 2 weeks while ECCO guidelines recommend IV ganciclovir for 3–5 days followed by oral valganciclovir for 2–3 weeks. Methods: Patients with IBD who presented with CMV colitis from September 2018 to January 2023 were included in this retrospective analysis. Patients either received intravenous ganciclovir for 5 days, followed by oral valganciclovir for a total duration of 3 weeks (SMT) or oral valganciclovir for 3 weeks. Patients were then maintained on either mesalamine, azathioprine, or biological therapy and were followed up. Results: Of 214 patients of IBD during this study period, CMV colitis was seen in 1 CD patient (2%) and 19 in UC patients (11.58%). Of these, 3 (15%) patients were treatment naïve, 6 (30%) patients were on steroids and azathioprine, 5 (25%) patients were on mesalamine and azathioprine, and 2 (10%) patients were on adalimumab. A total of nine patients received standard medical treatment (SMT), of which one patient did not have the response and underwent rescue subtotal colectomy where 11 patients received oral valganciclovir with a 100% response rate. For maintenance, 40% of patients were restarted on azathioprine due to cost issues while anti-tumor necrosis factor was given in 25% of patients. Discussion and Conclusion: As compared to conventional SMT treatment for CMV colitis, lone oral valganciclovir therapy is equally effective, is cost-effective, and also obviates the need for hospitalization. After treatment of CMV colitis, for maintenance, azathioprine showed a good response without recurrent CMV infection at least for a 6-month follow-up.

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