Colchicine in the Prevention and Treatment of the Amyloidosis of Familial Mediterranean Fever

Abstract

To determine whether colchicine prevents or ameliorates amyloidosis in patients with familial Mediterranean fever, we followed 1070 patients with the latter disease for 4 to 11 years after they were advised to take colchicine to prevent febrile attacks. Overall, at the end of the study, the prevalence of nephropathy was one third of that in a study conducted before colchicine was used to treat familial Mediterranean fever. Among 960 patients who initially had no evidence of amyloidosis, proteinuria appeared in 4 who adhered to the prophylactic schedule and in 16 of 54 who admitted non-compliance. Life-table analysis showed that the cumulative rate of proteinuria was 1.7 percent (90 percent confidence limits, 0.0 and 11.3 percent) after 11 years in the compliant patients and 48.9 percent (18.8 and 79.0 percent) after 9 years in the noncompliant patients (P less than 0.0001). A total of 110 patients had overt nephropathy when they started to take colchicine. Among 86 patients who had proteinuria but not the nephrotic syndrome, proteinuria resolved in 5 and stabilized in 68 (for more than eight years in 40). Renal function deteriorated in 13 of the patients with proteinuria and in all of the 24 patients with the nephrotic syndrome or uremia. We conclude that colchicine prevented amyloidosis in our high-risk population and that it can prevent additional deterioration of renal function in patients with amyloidosis who have proteinuria but not the nephrotic syndrome.

The role of adalimumab in the treatment of colchicine-resistant familial mediterranean fever: a case report

“…The joint involvement subsides within days, however in about 5% of patients destructive arthritis involving mainly the large joints many ensue [22]. The mainstay medication for treatment of FMF and amyloidosis prophylaxis is colchicine at a dose of 1.5-2mg daily [23,24]. However, in 5 to 15% of patients treatment fails and they get labeled as non-responders.…”

Is colchicine therapy effective in all patients with secondary amyloidosis?

“…4,8 With a presence of amyloidosis, approximately 20% percent of patients had nephrotic range proteinuria and renal functions were deteriorated in all of these patients with nephrotic syndrome. 4 In patients who have non-nephrotic proteinuria, improvement of proteinuria reported approximately in 6% and stabilization in 79%. 4 In our study, decreasing of proteinuria higher than 50% was defined approximately in 80% of patients with non-nephrotic proteinuria.…”

“…4 In patients who have non-nephrotic proteinuria, improvement of proteinuria reported approximately in 6% and stabilization in 79%. 4 In our study, decreasing of proteinuria higher than 50% was defined approximately in 80% of patients with non-nephrotic proteinuria. Our study revealed that, colchicine treatment reduced proteinuria in half of the patients with nephrotic syndrome.…”

“…1,3 There are few anecdotal reports about improvement of proteinuria with colchicine treatment in the course of renal amyloidosis; however, there is no sufficient data about long-term response of proteinuria and renal functions to colchicine treatment in patients with amyloidosis except FMF. [4][5][6] In this study, we aimed to evaluate the effect of colchicine treatment in renal amyloidosis patients due to various etiologies and clinical presentations.…”

Usefulness of Serum Hepatocyte Growth Factor for the Diagnosis of Amyloidosis.

“…Treatment of this disease is often difficult, because there are few specific therapies available. However, it has been reported that the prognosis of amyloidosis can be improved by appropriate early treatment, for example using melphalan (15), colchicine (15,16), and 4'-iodo-4'-deoxydoxorubicin (17). Thus, there has been a growing demand for the development of a specific noninyasive diagnostic technique.…”