Background Recommended colchicine dose in familial mediterranean fever (FMF) is 1–1.5 mg/day in adults. If necessary it can be increased up to 3 mg/day by clinical monitoring. In the final FMF recommendation report of the EULAR, it was reported that after 5 years of stable disease, in appropriate patients, the dose of colchicine may be reduced by close follow-up. However, the number of clinical trials supporting this recommendation is not enough.
Objectives In this study, demographic and clinical characteristics of FMF patients whose disease under control and treated with different doses of colchicine were compared.
Methods Among the all FMF patients attending to the rheumatology outpatient clinic between April and September 2016, only the patients in non-attacks period at least for the last 1 month were included to the study. Clinical and laboratory findings, MEFV gene mutations, drug compliance of the patients and duration and doses of the colchicine treatment were recorded. The 'international severity scoring system for familial mediterranean fever' (ISSF) score was calculated to determine disease severity. The patients who were under the control (less than 4 attacks per year and ISSF score ≤2) divided to three gruops. These gruops were the patients taking low dose (average daily dose of colchicin <1 mg), median dose>1 mg/day and<1.5 mg/ day and standard dose ≥1.5 mg/colchicine treatment at least for 3 years. Patients treated with DMARDs or biological therapy were excluded from the study.
Results Of the 162 FMF patients enrolled into the ongoing cohort, 86 patients were excluded from the study due to 57 patients had active disease, 19 had not yet completed 3 years of colchicine treatment and 10 patients received biological or DMARD treatment. The remaining 76 patients (25 male, 51 female) met the study criteria. The mean age was 32±11.5 years and the disease duration was 18.2±10.9 years. Amyloidosis or organ failure was not detected in any of these patients. Because of various reasons (drug side effect, treatment incompatibility, physician advice), 16 patients (21%) were treated with low dose colchicine (group A), 30 patients (39%) with moderate dose of colchicine (group B) and the remaining 30 patients (39%) with standard dose colchicine (group C). There were no statistically significant differences in demographic, clinical or laboratory data among these 3 subgroups.
Conclusions Disease control in FMF is important to prevent amyloidosis and improve the quality of life. Recent studies contribute to the determination of treatment goals. Reducing the colchicine dose may increase drug compliance in this lifelong treatment. In our study, there was no difference between the treatment groups in amyloidosis, MEFV gene mutation or subclinical inflammation. These findings suggest that the dose of colchicine maybe reduced in inactive patients who determineted by the number of annual episodes and the ISSF score.
Disclosure of Interest None declared