Related Experiment Video
Updated: Jan 18, 2026
Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response
Published on: October 3, 2019
How Physicians Manage Colchicine-Resistant Familial Mediterranean Fever: Insights From a Multinational Survey in
Veysel Cam1, Dilara Unal1, Erdal Sag1
1V. Cam, MD, D. Unal, MD, E. Sag, MD, O. Basaran, MD, Y. Bilginer, MD, S. Ozen, MD, Hacettepe University, Department of Pediatrics, Division of Rheumatology, Ankara, Türkiye.
Objective:
This study aimed to investigate real-world clinical practices regarding biologic therapy in colchicine-resistant familial Mediterranean fever (FMF), focusing on treatment initiation, tapering, discontinuation strategies, and related challenges.
Methods:
A 29-item English-language survey was distributed to pediatric and adult rheumatologists via email. The target population consisted of rheumatologists from Türkiye, Israel, and Italy (countries with a high prevalence of FMF) as well as Germany, where migrants of eastern Mediterranean origin live. The survey addressed preferences for biologic agents, colchicine compliance, tapering strategies, injection-site reaction management, and responses to trigger-related attacks.
Results:
A total of 126 clinicians responded. In the absence of regulatory constraints, 72.2% preferred canakinumab for colchicine-resistant FMF. The majority (94.4%) considered the standard dose of 2 mg/kg/day sufficient. Gradual extension of dose intervals was the most common tapering strategy. Whereas canakinumab was often tapered to dosing intervals of every 3-4 months, anakinra was tapered by extending the dosing interval to weekly administration in some cases. More than half (53.9%) observed a decline in colchicine compliance after starting biologics. Although 51.7% and 53.3% reported full efficacy after restarting anakinra and canakinumab, respectively, some clinicians noted reduced responses. Adult rheumatologists were more likely than pediatricians to support lifelong biologic therapy and reported greater concerns regarding colchicine compliance.
Conclusion:
Pediatric rheumatologists tended to favor discontinuation of biologic therapy rather than lifelong use. On-demand use of biologics also emerged as a treatment approach among treating physicians. Issues such as colchicine compliance, disease-specific triggers, and the potential to maintain efficacy upon reintroduction of interleukin 1 inhibitors after discontinuation should be prioritized in future research.
Related Concept Videos
01:21Rheumatic Heart Disease III: Medical Management
01:17Pericarditis III: Medical Management
01:14Myocarditis III: Medical Management
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:22Myocarditis IV: Nursing Management
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...