• For the majority of patients, colchicine is highly effective in preventing flares of FMF (and thus reducing incidence of secondary amyloidosis ). Gastrointestinal (GI) side effects are often a dose-limiting barrier; gradually increasing to the goal dose can help minimize GI symptoms.
• Colchicine administered in this setting is typically given indefinitely, presuming normal renal and liver function.
• Among patients with established nephrotic syndrome from AA, colchicine reduces the risk of further progression as well as proteinuria.
Higher doses of colchicine have been found to be more effective (1.8 mg/day)
Patients with significant renal insufficiency (creatinine ≥1.5 mg/dL) may not experience an improvement in proteinuria with colchicine, and dosing may be limited by renal disease.
Anecdotal data exists for azathioprine and IL-1 inhibition as adjuncts to colchicine in this setting.
• The IL-1β inhibitors anakinra and canakinumab are also effective in FMF.
Data regarding the effectiveness of these medications for the prevention of secondary amyloidosis is limited; as such, most experts suggest using these agents in addition to colchicine if possible.