Colchicine Treatment can be Stopped in a Selected Group of FMF Patients

Objectives: FMF patients are treated with a life-long prophylactic treatment with colchicine, mainly in order to prevent amyloidosis. As some patients may be asymptomatic for long periods of time, the question of whether it is possible to discontinue colchicine treatment - in a selective group of patients – arises. We aimed to identify patient characteristics that can predict successful cessation of colchicine therapy.

Methods: Out of 646 FMF pediatric patients followed in our referral FMF clinic, colchicine treatment was discontinued in 51 patients. In this study we compared the genetic, demographic and clinical characteristics between patients for whom a successful cessation of therapy was made (Group 1; n=21) and patients for whom cessation of therapy was deemed a failure (Group 2; n=30) and consequently had to resume colchicine therapy.

Results: Genetic analysis showed that none of the patients in group 1 harbored biallelic pathogenic MEFV mutations (0% vs 33%; P=0.0032). Severe attacks (two or more FMF characteristic symptoms) were more prevalent in patients who failed colchicine cessation (24% vs 80%; P=0.000067). None of the patients who remained colchicine free, required a colchicine dose higher than 1 mg/day prior to the drug cessation. Remission duration under colchicine treatment was significantly higher in group 1 compared with group 2 (4.36 years ± 2.12 vs 2.53 years ± 2; P=0.0036).

Conclusion: This study supports the concept of colchicine free remission in a minority of FMF patients (3%). Holding treatment may be reasonable when selecting the appropriate patients and under close monitoring.