Canakinumab treatment in patients with colchicine-resistant familial mediterranean fever: a multicenter observational
Emrah Koç1, Mete Pekdiker2, Mete Kara3
1Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkiye.
Background/Aim:
Anti-interleukin-1 agents have known beneficial effects in the treatment of colchicine-resistant familial Mediterranean fever (cr-FMF); however, studies to date have tended to have small sample sizes and to be based on pooled data. The present study investigates the efficacy of Canakinumab (CAN) in a homogeneous cohort of cr-FMF cases.
Materials And Methods:
The study included patients who underwent treatment in three tertiary rheumatology departments, whose electronic medical records were reviewed retrospectively. The inclusion criteria were presence of colchicine resistant disease activity or persistent proteinuria secondary to AA-amyloidosis, and treatment with CAN for at least 6 months. Clinical and laboratory parameters were assessed before and after CAN treatment.
Results:
The study included 65 patients with a mean age of 38.2 ± 13.8 years, with a mean disease duration of 23.7 ± 11.4 years and a mean colchicine dosage of 1.5 ± 0.6 mg/day. Of the total, 60% of the patients had an M694V homozygous mutation, and 41.5% were resistant to Anakinra. Furthermore, 25 had FMF-related amyloidosis, and 16 were renal transplant recipients. The mean CAN treatment duration was 31.3 ± 23.1 months, and 80% of patients achieved complete remission, while 20% achieved partial remission. Erythrocyte sedimentation rate, C-reactive protein, frequency of attacks, and patient global assessment decreased significantly after CAN (p < 0.001 for each). The mean serum creatinine level (mg/dl) decreased from 2.1 ± 0.8 to 1.4 ± 0.8 (p < 0.001), and median proteinuria (mg/day) decreased from 1475 to 675 (p < 0.001) in patients with AA-amyloidosis. Only one patient with chronic monoarthritis affecting the wrist discontinued CAN due to insufficient arthritis relief.
Conclusion:
Canakinumab demonstrates excellent efficacy and favorable safety as a treatment for cr-FMF. Our study is the first to indicate the efficacy of CAN in reducing serum creatinine levels.
Insights
Canakinumab (CAN) effectively treats colchicine-resistant familial Mediterranean fever (cr-FMF), achieving remission in 80% of patients. This study also shows CAN significantly reduces serum creatinine levels in cr-FMF patients.
Area of Science:
- Rheumatology
- Immunology
- Genetics
Background:
- Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disorder.
- Colchicine-resistant FMF (cr-FMF) presents a therapeutic challenge.
- Anti-interleukin-1 agents show promise for cr-FMF, but require further investigation in homogeneous cohorts.
Purpose of the Study:
- To investigate the efficacy and safety of Canakinumab (CAN) in a homogeneous cohort of cr-FMF patients.
- To assess the impact of CAN on clinical and laboratory parameters, including renal function.
Main Methods:
- Retrospective review of electronic medical records from three tertiary rheumatology departments.
- Inclusion criteria: cr-FMF with active disease or AA-amyloidosis, treated with CAN for ≥6 months.
- Assessment of clinical and laboratory parameters before and after CAN treatment.
Main Results:
- 65 patients with cr-FMF (mean age 38.2 years, mean disease duration 23.7 years) were included.
- 80% achieved complete remission and 20% partial remission with CAN treatment (mean duration 31.3 months).
- Significant reductions observed in inflammatory markers, attack frequency, and patient global assessment (p < 0.001).
- Mean serum creatinine decreased from 2.1 to 1.4 mg/dl (p < 0.001) and proteinuria decreased from 1475 to 675 mg/day (p < 0.001) in patients with AA-amyloidosis.
Conclusions:
- Canakinumab demonstrates excellent efficacy and a favorable safety profile for treating cr-FMF.
- This study is the first to report the efficacy of CAN in improving renal parameters, specifically reducing serum creatinine levels in cr-FMF patients.
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