علاج حمى البحر المتوسط العائلية عند فشل الكولشيسين في السيطرة على النوبات

References

DOI: 10.1136/annrheumdis-2015-208690

• Evidence for therapeutic options for patients resistant or intolerant to colchicine is limited, but case reports and case series have suggested that IL-1 blockade is a promising second-line therapy.
• A recent small randomised controlled trial (n=14) of the IL-1 blocker rilonacept in colchicine-resistant patients with FMF reported a significant reduction in the number of attacks.
• Phase III trials with canakinumab and anakinra are currently being conducted.
• Tumour necrosis factor (TNF) inhibitors have also been used in colchicine-resistant patients, especially with articular involvement, with good responses reported in observational studies.
• It is recommended that colchicine should be coadministered with alternative biological therapies given that it may reduce the risk of amyloidosis despite persistence of attacks.
• The ultimate goal of treatment in FMF is to obtain complete control of unprovoked attacks and minimise subclinical inflammation in between attacks.