Interventions for reducing inflammation in familial Mediterranean fever

Area of Science:

• Rheumatology and Immunology
• Genetics and Hereditary Diseases
• Pharmacology and Therapeutics

Background:

• Familial Mediterranean fever (FMF) is a hereditary auto-inflammatory disease primarily affecting Mediterranean populations.
• Colchicine has been historically used for FMF, but alternatives are sought for colchicine-resistant or intolerant patients.
• This review updates evidence on interventions for FMF, considering newer therapeutic options.

Purpose of the Study:

• To evaluate the efficacy and safety of various interventions aimed at reducing inflammation in individuals with Familial Mediterranean Fever.
• To synthesize findings from randomized controlled trials (RCTs) assessing different treatment strategies for FMF.

Main Methods:

• Comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, CBM, CNKI, Wan Fang, VIP) and clinical trial registries.
• Inclusion of randomized controlled studies (RCTs) comparing active interventions (colchicine, anakinra, rilonacept, etc.) against placebo or other active treatments.
• Independent data extraction, risk of bias assessment, and meta-analysis using GRADE approach for evidence quality.

Main Results:

• Nine RCTs with 249 participants were included, evaluating colchicine, ImmunoGuard™, rilonacept, and anakinra.
• Limited evidence suggests three-times-daily colchicine may reduce attack frequency (low-quality evidence).
• Rilonacept and anakinra showed no significant reduction in attacks for colchicine-resistant patients; anakinra may reduce C-reactive protein (moderate-quality evidence).

Conclusions:

• Current evidence for FMF interventions is limited, with some support for colchicine's efficacy in reducing attacks.
• Anakinra may offer benefits for C-reactive protein reduction in specific patient groups.
• Further high-quality RCTs are essential to establish definitive efficacy and safety profiles for various FMF treatments.