Utility of Anti–Melanoma Differentiation–Associated Gene 5 Antibody Measurement in Identifying Patients With Dermatomyositis and a High Risk for Developing Rapidly Progressive Interstitial Lung Disease: A Review of the Literature and a Meta-Analysis

Authors

  • Zhiyong Chen,

    1. Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
    Search for more papers by this author
    • Drs. Chen and Cao contributed equally to this work.

  • Mengshu Cao,

    1. Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
    Search for more papers by this author
    • Drs. Chen and Cao contributed equally to this work.

  • Maria Nieves Plana,

    1. Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
    Search for more papers by this author
  • Jun Liang,

    1. Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
    Search for more papers by this author
  • Hourong Cai,

    1. Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
    Search for more papers by this author
  • Masataka Kuwana,

    Corresponding author
    1. Keio University School of Medicine, Tokyo, Japan
    • Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, ChinaDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. E-mail: kuwanam@z5.keio.jp lingyunsun2001@yahoo.com.cn

    Search for more papers by this author
    • Dr. Kuwana holds a patent on an anti-MDA5 antibody measuring kit.

  • Lingyun Sun

    Corresponding author
    1. Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
    • Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, ChinaDivision of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. E-mail: kuwanam@z5.keio.jp lingyunsun2001@yahoo.com.cn

    Search for more papers by this author

Abstract

Objective

To assess the utility of anti–melanoma differentiation–associated gene 5 (anti-MDA5) antibody measurement for predicting a risk for developing rapidly progressive interstitial lung disease (RP-ILD) in patients with polymyositis/dermatomyositis (PM/DM).

Methods

A single-center cohort of 64 consecutive Chinese patients with PM/DM was examined. Serum anti-MDA5 antibody was measured by enzyme-linked immunosorbent assay. For meta-analysis, we searched PubMed and the Institute for Scientific Information Web of Knowledge for original studies that measured anti-MDA5 antibodies in patients with PM/DM. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the summary receiver operating characteristic (sROC) curve.

Results

In Chinese patients, anti-MDA5 antibodies were detected in 26 patients with classic DM or clinically amyopathic DM (CADM). Compared with anti-MDA5–negative patients, anti-MDA5–positive patients showed a higher prevalence of RP-ILD (P = 0.001). In a total of 233 patients with anti-MDA5 antibody, derived from 16 studies, a higher frequency of CADM was found in Japanese than in non-Japanese patients (74.7% versus 39.2%; P = 1.2 × 10−7). Meta-analysis revealed that the pooled sensitivity and specificity of anti-MDA5 antibody for RP-ILD was 77% (95% confidence interval [95% CI] 64–87%) and 86% (95% CI 79–90%), respectively. The pooled DOR was 20.41 (95% CI 9.02–46.20) with a favorable area under the sROC curve of 0.89 (95% CI 0.63–0.98).

Conclusion

Detection of anti-MDA5 antibody is a valuable tool for identifying DM patients with a high risk for developing RP-ILD, but the distribution of classic DM and CADM in patients with this antibody varies among ethnic groups.

Ancillary