Colchicine-Free Remission May Be Achieved in Pediatric Familial Mediterranean Fever

Certain patients with Familial Mediterranean Fever (FMF) may be able to achieve colchicine-free remission, and holding treatment in these patients may be reasonable, according to study results published in Pediatric Rheumatology.

FMF is a monogenic autoinflammatory disease that causes recurrent inflammatory attacks and is thought to necessitate life-long treatment with colchicine to prevent amyloidosis.

At a medical center in Israel, children with FMF were able to discontinue colchicine treatment after a long period of remission.

Clinical characteristics and outcomes were compared between the patients who maintained colchicine-free remission and those who reinitiated colchicine treatment.

Severe attacks were defined as fever accompanied by at least 2 of the following symptoms: arthritis, erysipelas like erythema, orchitis, peritonitis, and pleuritis.

Patients with and without colchicine-free remission were aged a mean of 4.14±3.08 and 4.42±3.74 years at disease onset; the ratios of male to female were 10:11 and 17:13; 48% and 77% had a family history of FMF; received colchicine for 6.35±2.76 and 5.69±4.33 years; and maintained remission during treatment for 4.36±2.12 and 2.53±2.0 years, respectively.

In general, the subset of children who achieved colchicine-free remission vs those who reinitiated colchicine had lower Pras scores (mean, 7.14 vs 8.43 points; P =.0058) and fewer of them had severe attacks (24% vs 80%; P =.000067),arthritis symptoms during FMF attacks (33% vs 70%; P =.0096), nonattack exertional leg pain (10% vs 50%; P =.0025), respectively.

All patients who maintained colchicine-free remission required a maximum dose of 1 mg/day vs 40% of those who reinitiated treatment required higher doses (P =.0009).

Significant predictors for disease relapse included receiving a colchicine dose of more than 1 mg/day vs a dose of 1 mg/day or lesser, prior to discontinuation (hazard ratio [HR], 4.09; 95% CI, 1.73-9.69; P =.0013) and having severe vs mild attacks (HR, 3.23; 95% CI, 1.004-7.49; P =.0492).

One of the study limitations was the missing genetic information for some patients.

The study authors concluded, “This study supports the concept of colchicine-free remission (remission while not taking colchicine) in a minority of FMF patients (3%). […] As current data on colchicine cessation are limited and retrospective, a prospectively designed trial is required to test the hypothesis that alleviating the lifelong colchicine burden in [patients with] FMF is feasible.”