JAK Inhibitors in Colchicine Resistant FMF Patients: A Case-Based Review.

Background: Familial Mediterranean Fever (FMF) is an autoinflammatory disorder typically controlled with colchicine; however, 5-10% of patients exhibit colchicine resistance or intolerance. Although biologic therapies targeting IL-1 may be effective, their cost and limited accessibility create a need for alternative oral treatments. Janus kinase (JAK) inhibitors have emerged as potential modulators of multiple inflammatory pathways implicated in FMF pathogenesis. Methods: We conducted a retrospective case series of three adults with colchicine-resistant FMF who had previously demonstrated partial but inadequate responses to colchicine and dapsone combination therapy. All patients-initiated treatment with an oral JAK inhibitor at 5 mg twice daily. None of the patients had received IL-1 or IL-6 inhibitors prior to JAK inhibitor therapy. Clinical outcomes, including attack frequency, remission status, and adverse events, were documented over 9-12 months of follow-up. Results: All three patients achieved complete remission, defined as the absence of any FMF attacks throughout the follow-up period. No infectious, hematologic, thrombotic, or hepatic adverse events were observed. Conclusion: JAK inhibitor therapy was associated with rapid, complete, and sustained remission in adults with colchicine-resistant FMF. These findings support the growing evidence that JAK inhibition may offer an effective oral alternative to biologics in refractory FMF.