Background The association between antiphospholipid antibodies (aPL) and multiple sclerosis (MS) is controversial.
Objectives To evaluate whether aPL relate to MS and its severity.
Methods Systematic review of EMBASE and PubMed from inception to October 2015 according to PRISMA guidelines. Peto's meta-analysis for rare events.
Results The relationship between aCL (anticardiolipin) antibody of either IgG/IgM isotype and MS was addressed in 10 case control studies totalling 801 controls and 614 MS patients; the pooled prevalence for IgG was 1.9% in controls and 6.8% in MS yielding an odds ratio (OR) of 3.602 (95% CI 2.005, 6.471); the pooled prevalence for IgM aCL was 2.49% in controls and 10.7% in MS patients yielding an OR of 4.720 (95% CI 2.828, 7.877). The relationship between anti-beta2glycoprotein-I (aβ2GPI) of IgG isotype and MS was addressed in 5 case control studies totalling 405 controls and 401 MS patients; the pooled prevalence was 5.18% in controls and 1.24% in MS yielding an OR of 0.230 (95% CI 0.086, 0.618); the relationship between IgM aβ2GPI and MS was addressed in 5 case control studies totalling 379 controls and 367 MS patients; the pooled prevalence for the IgM isotype was 2.49% in controls and 10.7% in MS patients yielding an OR of 3.251 (95% CI 1.805, 5.855). The relationship between anti-prothrombin antibody (aPT) of IgG isotype and MS was addressed in 3 case control studies totalling 328 controls and 260 MS patients; the pooled prevalence was 9.75% in controls and 4.61% in MS yielding an OR of 0.447 (95% CI 0.225, 0.887).
Three studies addressed the relationship between aPL and MS employing as controls patients with ischaemic stroke (IS) totalling 599 IS and 505 MS patients. The pooled prevalence of IgG aCL in IS was 8.9% and in MS was 6.34% for an OR of 1.011 (95% CI non evaluable). The pooled prevalence of IgM aCL in IS was 6.84% and in MS was 9.72% for an OR of 0.995 (95% CI non evaluable). The relationship between aCL of either isotype and stable/active MS was evaluated in 4 case control studies totalling 200 stable/remission MS patients and 84 active/relapsing MS patients. The pooled prevalence of IgG aCL in the former was 19.5% and in the latter 22.6% for an OR of 1.206 (95% CI 0.649, 2.241) and likewise the pooled prevalence of IgM aCL was 21% and 36.9% respectively for an OR of 0.150 (95% CI 0.086, 0.264). The relationship between aβ2GPI of either isotype and different disease stages of MS was evaluated in 123 stable/remission MS patients and 69 active/relapsing MS. The pooled prevalence of IgG β2GPI was 1.62% in stable/remission MS and 20.2% in active/relapsing MS for an OR of 15.4 (95% CI 3.383, 70.095). The pooled prevalence of IgM β2GPI was 3.2% in stable/remission MS and 40.5% in active/relapsing MS for an OR of 20.3 (95% CI 6.721, 61.411).
Conclusions The calculated OR suggest that IgG/IgM aCL and IgM aβ2GPI are weakly associated with MS and that IgG/IgM β2GPI are associated with active/relapsing MS though with very wide CIs. Most of the studies reported the percentage of positive aPL per group but not the average PL titre per group, precluding better assumptions on the relationships found.
Disclosure of Interest None declared
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