How Physicians Manage Colchicine-Resistant Familial Mediterranean Fever: Insights From a Multinational Survey in...

Area of Science:

• Rheumatology
• Clinical Immunology
• Genetics

Background:

• Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disorder requiring long-term management.
• Colchicine is the first-line treatment, but resistance necessitates alternative therapies like biologics.
• Understanding real-world biologic use in colchicine-resistant FMF is crucial for optimizing patient care.

Purpose of the Study:

• To investigate current clinical practices for biologic therapy in colchicine-resistant FMF.
• To assess treatment initiation, tapering, and discontinuation strategies for biologics.
• To identify challenges associated with biologic therapy in FMF management.

Main Methods:

• A 29-item survey was emailed to pediatric and adult rheumatologists in high-FMF prevalence countries (Turkey, Israel, Italy) and Germany.
• The survey focused on preferences for biologic agents, colchicine compliance, tapering, and management of treatment-related issues.
• Responses from 126 clinicians were analyzed to understand real-world practices.

Main Results:

• Canakinumab was the preferred biologic (72.2%) for colchicine-resistant FMF in the absence of regulatory issues.
• Gradual extension of dose intervals was the most common tapering strategy for biologics.
• Over half of clinicians observed decreased colchicine compliance after initiating biologics, with adult rheumatologists more concerned about this.

Conclusions:

• Paediatric rheumatologists leaned towards discontinuing biologic therapy, while adult rheumatologists favored lifelong use.
• On-demand biologic use emerged as a treatment strategy.
• Future research should address colchicine compliance, FMF triggers, and the efficacy of reintroducing IL-1 inhibitors after discontinuation.