Background/Purpose: To review the patients followed in our center with FMF who received anakinra, an anti IL-1 receptor antagonist, because of insufficient colchicine response. 

Methods: FMF patients who were treated with anakinra were retrospectively reviewed with regard to indication, effect on disease activity and acute phase response, adverse events. Patient global assessment was recorded before and after anakinra treatment. 

Results:

There were 38FMF patients with FMF who were treated with anakinra for various indications (amyloidosis in 11, colchicine resistant recurrent febrile attacks in 22, colchicine related side effects in 5). Two patients were excluded since they have been on anakinra for less than one month (one with amyloidosis, one pregnant). The mean age of the group was 35.6±11.2 years. The mean duration of the disease was 23.1 ±12,0 years. There were various co-existing pathologies among this study group like multiple sclerosis (1), ankylosing spondylitis (1), SLE (1), Behçet’s disease (1), low grade lymphoma (1) and PAN (2). Six patients were pregnant. The mean colchicine dose was 2,09±0,49 mg/d. The mean duration of anakinra treatment was 19.6± 13.2 months. Twenty seven patients reported no attacks after anakinra treatment whereas 5 patients reported at least 50% decrease in the attack frequency. Mean patient global assessment decreased from 8.75±2.1 to 1.72±2.6 under anakinra treatment (p=0.001).

Among the 10 patients with amyloidosis, anakinra was stopped in 2 patients because of increased proteinuria. However, a significant decrease in proteinuria was detected in 5 patients. One patient developed severe injection site reaction and therefore the drug was stopped. Overall, 7 of our patients with amyloidosis are still on Anakinra treatment.

Three patients had a severe allergic reaction (severe disseminated rash in 1 patient and severe injection site reaction in 2 patients) and therefore the drug was stopped. Two patients had infections (one had genital warts and urinary tract infection, the other had sinusitis and folliculitis) and the treatment was terminated. One of our patients reported that her psoriatic lesions got worse on anakinra. Twenty six patients reported no adverse events during the treatment. 

Conclusion:

Anakinra was effective in controlling the symptoms in colchicine-resistant FMF cases. It was also effective in FMF related amyloidosis. The major cause of treatment termination was injection site reactions. Anakinra seems to be an effective alternative in patients who have insufficient response to colchicine.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/anakinra-treatment-in-patients-with-familial-mediterranean-fever-a-single-center-experience/