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Real world experience with antiphospholipid antibody tests: how stable are results over time?

¹ Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
² Faculty of Medicine Sciences, University of Groningen, Groningen, Netherlands
³ Morehouse School of Medicine, Atlanta, Georgia, USA
⁴ University of North Carolina, Chapel Hill, North Carolina, USA

Correspondence to:
Correspondence to:
Dr Doruk Erkan
Department of Rheumatology, Hospital for Special Surgery, 535 E70th Street, New York, NY 10021, USA; derkan{at}pol.net

Objective: To determine the stability and the degree of variation of antiphospholipid antibody (aPL) results over time in a large cohort of well evaluated aPL positive patients; and to analyse factors contributing to aPL variation and the validity of aPL in a real world setting in which aPL tests are done in multiple laboratories.

Methods: The clinical characteristics, drug treatment, and 1652 data points for lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and anti-ß₂ glycoprotein I antibodies (anti-ß₂GPI) were examined in 204 aPL positive patients; 81 of these met the Sapporo criteria for antiphospholipid syndrome (APS) and 123 were asymptomatic bearers of aPL.

Results: 87% of initially positive LA results, 88% of initially negative to low positive aCL results, 75% of initially moderate to high positive aCL results, 96% of initially negative to low positive anti-ß₂GPI results, and 76% of initially moderate to high positive anti-ß₂GPI results subsequently remained in the same range regardless of the laboratory performing the test. Aspirin, warfarin, and hydroxychloroquine use did not differ among patients whose aCL titres significantly decreased or increased or remained stable. On same day specimens, the consistency of aCL results among suppliers ranged from 64% to 88% and the correlation ranged from 0.5 to 0.8. Agreement was moderate for aCL IgG and aCL IgM; however, for aCL IgA agreement was marginal.

Conclusions: aPL results remained stable for at least three quarters of subsequent tests, regardless of the laboratory performing the test; the small amount of variation that occurred did not appear to be caused by aspirin, warfarin, or hydroxychloroquine use.

Abbreviations: aCL, anticardiolipin antibody; aPL, antiphospholipid antibody; APLASA, asymptomatic aPL positive registry; APS, antiphospholipid syndrome; APSCORE, antiphospholipid syndrome collaborative registry; GPI, glycoprotein I; LA, lupus anticoagulant

Keywords: antiphospholipid syndrome; antiphospholipid antibodies