How is Familial Mediterranean fever treated?
- • 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.
