Some patients with familial Mediterranean fever may achieve colchicine-free remission
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A small minority of patients with familial Mediterranean fever may be able to achieve colchicine-free remission, according to data published in Pediatric Rheumatology.
Patients who successfully discontinued therapy were typically those without biallelic pathogenic MEFV mutations, who were less likely to demonstrate severe attacks and did not require more than 1mg of daily colchicine prior to drug cessation, the researchers concluded.
“The mainstay of [familial Mediterranean fever (FMF)] treatment is colchicine, which reduces the frequency as well as the intensity of disease exacerbations,” Karen Cohen, MD, of the Sackler Faculty of Medicine, at Tel Aviv University, in Israel, and colleagues wrote.
“As some patients may be asymptomatic for long periods of time, the question of whether it is possible to discontinue colchicine treatment — in a selective group of patients — arises,” they added. “In recent years, few studies showed colchicine-free remission in FMF patients but there are no detailed recommendations to whom colchicine cessation can be tried.”
To investigate the feasibility of discontinuing colchicine in pediatric patients with familial Mediterranean fever, as well as identify patient characteristics that may predict a successful cessation, Cohen and colleagues conducted a retrospective study using data collected from the Israeli National Center for FMF, at Sheba Medical Center, between 2007 and 2020. The researchers separated data from patients who had discontinued therapy following disease remission of at least 1 year. Following discontinuation, patients were recommended follow-ups every 4 to 6 months.
Patients who demonstrated recurring symptoms, elevated acute phase reactants, or elevated Serum Amyloid A were reinitiated on therapy. During analysis, patients who discontinued therapy were sorted into two groups. The first group remained in remission, off therapy, while the second had therapy reinitiated. The researchers collected clinical and laboratory data — including fever episodes, arthritis, abdominal pain, erysipelas, inflammatory markers, demographic data and relevant family histories — for both groups.
Among the 51 patients who discontinued therapy, 21 demonstrated a successful discontinuation while 30 were required to resume therapy. According to the researchers, the group of patients who successfully ceased therapy had no biallelic pathogenic MEFV mutations, were less likely to have two or more characteristic symptoms of familial Mediterranean fever, and received 1 mg or less per day of colchicine. Additionally, patients who successfully ceased therapy were able to achieve a significantly longer remission while receiving therapy, at 4.36 ± 2.12 years, compared with 2.53 ± 2 years (P = .0036).
“This study supports the concept of colchicine free remission (remission while not taking colchicine) in a minority of FMF patients (3%),” Cohen and colleagues wrote. “Holding treatment may be reasonable when selecting the appropriate patients and under close monitoring. As current data on colchicine cessation are limited and retrospective, a prospectively designed trial is required to test the hypothesis that alleviating the lifelong colchicine burden in FMF patients is feasible.”
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