Successful management of colchicine resistant familial Mediterranean fever patients with a standardized canakinumab treatment protocol: a case series and literature review

• Published in: Rheumatology international Vol. 40; no. 1; pp. 161 - 168
• Main Authors: Eren Akarcan, Sanem, Dogantan, Seyda, Edeer Karaca, Neslihan, Aksu, Guzide, Kutukculer, Necil
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2020; Springer Nature B.V
• Subjects: Adolescent; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - therapeutic use; Case Based Review; Child; Colchicine - therapeutic use; Drug Administration Schedule; Drug Resistance; Duration of Therapy; Familial Mediterranean Fever - drug therapy; Female; Fever; Humans; Literature reviews; Male; Medicine; Medicine & Public Health; Monoclonal antibodies; Retrospective Studies; Rheumatology; Treatment Outcome; Tubulin Modulators - therapeutic use; Young Adult; Colchicine resistance; Familial Mediterranean fever; Interleukin-1 receptor; Canakinumab
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-019-04366-w

Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease characterized by recurrent attacks of fever and serositis. Although colchicine is the first line treatment in FMF, 5–10% of patients do not respond to colchicine. Canakinumab, an anti-IL-1β monoclonal antibody, has been reported to be effective and safe in colchicine-resistant FMF patients, but the adequate duration and interval of treatment is still a matter of debate. Aim of this study was to evaluate the success of the standardized treatment protocol for canakinumab applied in our Pediatric Rheumatology Department in colchicine-resistant FMF cases with a review of the literature. Nine patients included in this study had indications for canakinumab use as colchicine resistance and recurrent corticosteroid need for pleural/pericardial effusions. Canakinumab was administered monthly for 6 months (initial treatment), bimonthly for 6 months (maintenance treatment), then treatment was discontinued. For the patients who developed a new attack after one-year treatment period, canakinumab was readministered with 3-month intervals (continuation treatment). The mean follow-up time beginning from the first canakinumab injection was 24.3 ± 10.2 (6–33) months. None of the patients had an attack during the first-year treatment. Four of the patients developed an attack 9.0 ± 2.9 (6–12) months after discontinuation of treatment and switched to the continuation treatment period, with no more attacks. We suggest that this standard protocol may be used successfully in colchicine-resistant FMF patients.