Background Approximately 5 to 10% of FMF patients do not respond to colchicine treatment and/or intolerant to colchicine because of side effects. Several case reports and case series have pointed out the efficacy of IL-1 blockade in colchicine resistant FMF subgroup.
Objectives To review the patients followed in our center with FMF who received Anakinra, an anti IL-1 receptor antagonist, in terms of outcome and side effects.
Methods 36 FMF patients who were treated with Anakinra were retrospectively reviewed with regard to indication, effect on disease activity and acute phase response, adverse events. Patient global assessment was recorded before and after Anakinra treatment. Nine patients were pregnant at the time of the treatment and reported previously (1).
Results There were 27 FMF patients with FMF who were treated with Anakinra for various indications (colchicine resistant recurrent febrile attacks in 21, colchicine related side effects in 6). The mean age of the 27 patients was 33.16±10.29 years. The mean duration of the disease was 19.29±10.94 years. There were various co-existing pathologies among this study group like Ankylosing Spondylitis (1), SLE (1), Behçet's disease (1) and Gout (1). The mean colchicine dose was 2.03±2.031 mg/d. The mean duration of anakinra treatment was 14,18± 18.39 months. Nine teen patients reported no attacks after anakinra treatment whereas 5 patients reported at least 50% decrease in the attack frequency and 3 patients reported less than 50% decrease in attack frequency. Mean patient global assessment decreased from 8,57±2,23 to 2,61±2,82 under Anakinra treatment (p<0.001)
As for the adverse events, four patients had allergic reactions under Anakinra treatment (severe disseminated rash in 1 patient and severe injection site reaction in 2 patients and tolerable injection side reaction in 1) therefore the treatment was terminated for 3 patients with severe allergic reactions. One patient had genital warts and urinary tract infection after the injections and Anakinra was stopped. One of our patients reported that her psoriatic lesions got worse on Anakinra. Twenty one patients reported no adverse events during the course of treatment.
Anakinra treatment was terminated in overall 11 patients for various reasons: Inadequate response in 3, allergic reactions in 3, flare in psoriatic plaques in 1, infection and genital warts in 1, full recovery in 2 and patient's preference in 1. Sixteen patients are still on Anakinra treatment.
Conclusions Colchicine resistance or intolerance in FMF, although not very common, is an issue in daily rheumatology practice. During our experience with Anakinra, we reported remarkable decrease in the frequency of attacks in many patients with relatively tolerable side effects. Among patients whom Anakinra treatment was terminated, the most common reason was injection site reaction. We state that Anakinra is an effective alternative in patients with inadequate response or intolerance
Ugurlu S, Ergezen B, Ozdogan H. Anakinra Treatment in Patients with Familial Mediterranean Fever: A Single-Center Experience [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10).
Disclosure of Interest None declared