Prophylactic colchicine for familial Mediterranean fever: response rates revisited

Complete response to colchicine is reported in 60-65% of patients with familial Mediterranean fever (FMF), partial response in 30-35%, and poor response in 5-10% of patients. The objective of our study was to revisit colchicine response rates for the common FMF gene (MEFV) genotypes in view of newly available treatments.

Data were retrieved from medical files of 106 consecutive FMF patients, who were divided into four groups: patients with complete response, having had no attacks in the past year; near complete, with one or two attacks; fairly controlled, with three to six attacks; and poorly controlled, with more than six attacks in the past year.

Only 34% of M694V homozygotes were adequately controlled, having had zero to two attacks in the past year, compared to 66% of the patients with all other genotypes combined (p < 0.002). Furthermore, 42% of M694V homozygotes were poorly controlled compared to 13% of all other genotypes combined (p < 0.001). Patients categorized as adequately controlled received a lower dose of colchicine compared to the rest of the cohort (p = 0.042). None of the patients had amyloidosis.

We found a relatively large group of FMF patients with inadequate response to colchicine. This underlines the importance of improving disease control and quality of life for patients with FMF.