Factors Affecting the Use of Colchicine in FMF Patients and Alternative Treatments in FMF Management: Limits of Colchicine and Solutions.

Objective: The main medication for treating Familial Mediterranean Fever (FMF) is colchicine. We aimed to identify situations that affect the response to colchicine in the treatment of FMF, such as ineffectiveness and side effects, and to discuss alternative treatments, with anti-IL-1 (anti-interleukin-1) agents being at the forefront in these situations. Material and Methods: Our research is a descriptive case series. The age, gender, disease duration, MEFV gene mutation, colchicine preparation used, doses, duration, anti-IL-1 preparation and doses used, duration, reason for intolerance to domestic and/or imported colchicine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum amyloid A (SAA) values at baseline and 3rd and 6th month visits in patients diagnosed with FMF followed and treated on an outpatient or inpatient basis in the internal medicine rheumatology clinic of our university, the presence and frequency of FMF attacks, their clinical status during attacks, and FMF complications (proteinuria, chronic kidney damage, dialysis status) were recorded retrospectively for 25 patients diagnosed with FMF. Results: During colchicine treatment, non-response was present in 19 patients (76%), diarrhea in four patients (16 liver dysfunction in six patients (24%), and myopathy in 1 patient (4%). For these reasons, treatment with anti-IL-1 agents was continued. Conclusion: Side effects such as diarrhea, elevated liver enzymes, myopathy, cytopenia or unresponsiveness limit the use of this medication. In this case, changing the colchicine preparation or switching to anti-IL-1 agents will help us overcome the difficulties in treatment and protect the patient from complications, such as secondary amyloidosis.