Introduction and purpose: Balance problems are common in people with multiple sclerosis (MS). Pilates can also be treatment strategy for people with MS, but there is inadequate evidence to support or refute the efficacy of Pilates, especially on balance in MS patients. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of Pilates exercises on balance in people with MS. Methods: We conducted a literature search of the Cochrane Library, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, OVID, Science Direct, and Scopus databases using the following search terms: multiple sclerosis, Pilates, core stability, balance, equilibrium, postural control. All content from the date of database inception to March 2021 was included in the search. Results: The initial search strategy based on date range and language yielded 246 relevant records and eight of them were about both Pilates and MS. According to this evaluation, we found the significant advantage of Pilates on balance in patients with MS, when compared to the control group in the Berg Balance Scale (SMD=1.017; 95% CI=-0.040, 1.994; p = 0.041), Activities-Specific Balance Confidence Scale (SMD=0.604; 95% CI=-0.078, 1.130; p = 0.024), Timed Up and Go Test (SMD=0.944; 95% CI=-0.022, 1.867; p = 0.045). But in the Functional Reach Test (SMD=1.846; 95% CI=-0.080, 3.772; p = 0.060), we did not found any difference between groups. Conclusions: Pilates exercises might be an optional method for improving balance in MS patients, however, we need further robust studies to prove whether it is more effective than other physiotherapy interventions.