Predictors of rapidly progressive interstitial lung disease in anti-MDA5 dermatomyositis: a meta-analysis

Anti-MDA5 antibody-positive DM (MDA5+DM) is frequently complicated by rapidly progressive interstitial lung disease (RP-ILD). The current study aims to identify predictors for the development of RP-ILD in MDA5+DM, thereby providing an objective basis for early intervention strategies.

We searched the PubMed, Embase, Web of Science and Cochrane Library databases and extracted studies published before December 2024. Two reviewers extracted data and assessed risk of bias. Population characteristics, clinical features and laboratory indicators were systematically summarized. For the overall main effects, results were presented as standardized mean differences (SMDs), odds ratios (ORs) and corresponding 95% CIs.

Twenty-seven cohorts with 2579 patients were included in this meta-analysis. The results demonstrated that clinical characteristics predictive of RP-ILD risk factors included advanced age, male sex, fever, skin ulcers and arthritis. Specifically, the RP-ILD group exhibited significantly elevated levels of laboratory parameters including CRP, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), ferritin, ESR, leukocytes, Krebs von den Lungen-6 (KL-6), alanine aminotransferase (ALT), cartilage glycoprotein 39, positive anti-Ro52 antibodies and high-titre anti-MDA5 antibodies. Conversely, the RP-ILD group demonstrated significantly reduced levels of lymphocytes, albumin, PaO2/FiO2 ratio and CD3+CD4+ T cell count.

This meta-analysis identified multiple clinical and laboratory parameters as significant predictors of RP-ILD progression in MDA5+DM patients. High-quality prospective studies are essential to validate these associations and identify additional biomarkers for the early prediction of RP-ILD onset in MDA5+DM patients, which will facilitate timely therapeutic interventions aimed at reducing mortality.