Table 1 Predictivity of anti-dsDNA antibodies in SLE flares
From: Predictive biological markers of systemic lupus erythematosus flares: a systematic literature review
Assay | Number of patients (n) | Findings | Study |
|---|---|---|---|
Positive results | |||
 CLIF | 61 | 67% of patients in the group with exacerbations had persistent anti-dsDNA ab versus 27% in the patient group without exacerbations | Oelzner et al., 1996 [14] |
 CLIF | 299 | Increased level at baseline was a risk factor for flare in the haematological system (p = 0.003) | Petri et al., 2009 [10] |
 CLIF | 65 | Cases, defined as experiencing a surge in anti-dsDNA from 0 to 3+/4+, or from 1+ to 4+, within a period of less than 12 months, were more likely to experience a severe flare than controls (OR 6.3 (CI 2.0–19.9), p = 0.02) | Pan et al., 2014 [25] |
 Farr | 487 | Frequency of renal flare was lower in patients with sustained reductions in anti-dsDNA ab (> 10% from baseline levels for at least 2/3 of all observed values) than in patients with stable or increasing antibody levels | Linnik et al., 2005 [24] |
 Farr | 130 | All 15 major exacerbations were preceded by an increase of the anti-dsDNA ab levels, with a doubling time of less than 6 weeks for 13 patients. There were four other patients with an increase in anti-dsDNA levels who did not show any exacerbation | Swaak et al., 1982 [11] |
 Farr | 143 | A continuous increase in the anti-dsDNA ab was found for all patients in the 24 weeks preceding exacerbations with a doubling time < 10 weeks | Swaak et al., 1986 [12] |
 Farr | 78 | A sharp drop in anti-dsDNA ab, usually preceded by a rise, was related to a serious exacerbation | Swaak et al., 1979 [4] |
 Farr | 151 | Anti-dsDNA increase started 4 months prior to the relapse and reached a maximum at the moment of relapse whereas no fluctuations were observed in patients with persistently inactive disease | Coremans et al., 1995 [15] |
 Farr | 23 | Presence of anti-dsDNA abs (> 5 IU/ml) or increase (> 25%) was associated with a high risk of renal flare | Matrat et al., 2011 [29] |
 Farr | 199 | Patients with anti-dsDNA ab (> 15 IU/ml) had a greater risk of developing proliferative glomerulonephritis than patients without auto-antibodies (p = 0.048) | Cortés-Hernà ndez et al., 2004 [22] |
 ELISA | 70 | Anti-dsDNA antibodies were detected in 14 (93.3%) of 15 patients with subsequent lupus nephritis, compared with 24 (72.7%) of 33 patients with active SLE and no nephritis (p = ns) and nine (73%) patients with inactive SLE and no nephritis (p = ns). Sensitivity for severe lupus nephritis was 100% | Meyer et al., 2009 [30] |
 Farr and EliA | 48 | All 22 exacerbations were accompanied by changes in anti-dsDNA (> 25%) in one or both assays | Hillebrand et al., 2013 [26] |
 CLIF and ELISA | 53 | Increase in anti-dsDNA ab predicted flares with M-SLEDAI and M-LAI indices | Ho et al., 2001 [17] |
 CLIF, ELISA and Farr | 72 | 89% of the exacerbations were preceded by a significant increase in anti-dsDNA ab levels (defined as ≥ 2 titres by the C. luciliae test or ≥ 25% and at least 100 IU/ml by the ELISA or ≥ 25% and at least 30 IU/ml by the Farr assay) | ter Borg et al., 1990 [13] |
 ELISA and Farr | 34 | Patients with rises in IgG class anti-dsDNA ab by ELISA (≥ 6 IU/ml) or in anti-dsDNA by Farr assay (≥ 15 IU/ml) had a significantly higher cumulative risk for relapses, with a median time of 2.3 and 2.1 months respectively | Bootsma et al., 1997 [16] |
 NA | 189 | Persistently positive anti-dsDNA after cyclophosphamide treatment was an independent predictor of renal flares | Mok et al., 2004 [23] |
 NA | 218 | The combination of complement C3, C4 and anti-dsDNA antibody is reasonably specific for predicting lupus flares in the preceding 4 weeks | To et al., 2011 [28] |
 NA | 562 | Elevated titres (≥ 200 IU/ml) at baseline were independent predictors of moderate-to-severe flares at week 52 | Petri et al., 2013 [9] |
Negative results | |||
 CLIF | 27 | Serial measurements of anti-dsDNA ab were poor markers of exacerbation. | Lloyd and Schur, 1981 [19] |
 Farr | 48 | Changes in anti-dsDNA ab failed to correctly predict a change in disease activity | Abrass et al., 1980 [18] |
 Farr | 202 | Fluctuations in anti-dsDNA ab were poor predictors of disease exacerbations according to SLEDAI | Esdaile et al., 1996 [20] |
 Farr | 120 | No consistent association between anti-dsDNA ab positivity and risk of flare defined by SLEDAI | Mirzayan et al., 2000 [6] |
 Farr | 46 | Baseline anti-dsDNA ab failed to predict renal relapses | El Hachmi et al., 2003 [8] |
 ELISA | 23 | Anti-dsDNA ab were not predictive of flare | Steiman et al., 2010 [21] |
 Farr and CLIF | 73 | No difference between the patients who flared and the patients who did not | Walz LeBlanc et al., 1994 [31] |
 NA | 57 | Percentage of patients who had positive anti-dsDNA ab at the time of the diagnosis was not higher in patients with a subsequent exacerbation | Tomioka et al., 2008 [7] |
 NA | 110 | Anti-dsDNA ab were not identified as a predictor of flare | Swaak et al., 1989 [5] |
 NA | 218 | Anti-dsDNA lacks sensitivity in predicting serosal and neuropsychiatric lupus flares | To et al., 2011 [27] |