Anakinra suppresses familial Mediterranean fever crises in a colchicine-resistant patient

Area of Science:

• Rheumatology
• Internal Medicine
• Genetics

Background:

• Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disorder characterized by recurrent episodes of fever and serositis.
• Colchicine is the established first-line treatment for FMF, effectively preventing attacks and amyloidosis.
• Treatment resistance or intolerance to colchicine necessitates exploring alternative therapeutic strategies.

Observation:

• A 34-year-old male patient with FMF presented with increased frequency and severity of disease attacks.
• The patient exhibited resistance to chronic colchicine treatment, indicating a need for alternative management.
• No established alternative treatment guidelines exist for colchicine-resistant FMF.

Findings:

• Anakinra, an interleukin-1 receptor antagonist, was administered to the patient during FMF crises.
• Unlike previous reports suggesting daily administration, anakinra was used on-demand, only during acute attacks.
• This intermittent, crisis-based anakinra administration resulted in a successful clinical outcome, managing FMF flares effectively.

Implications:

• Intermittent anakinra may represent a viable and potentially more tolerable treatment option for colchicine-resistant FMF.
• This approach offers a novel therapeutic strategy for managing FMF flares in patients unresponsive to standard care.
• Further research is warranted to validate the efficacy and safety of on-demand anakinra in a larger FMF patient cohort.