Is colchicine therapy effective in all patients with secondary amyloidosis?

Abstract

Objective: Although colchicine is effective on prevention and regression of amyloidosis in many cases, rate of unresponsiveness to colchicine therapy is not too low. However, there is no sufficient data about which factors effect to response of colchicine therapy on regression of amyloidosis. Materials and methods: 24 patients with renal amyloidosis were enrolled into the study. The patients were divided in two groups according to urinary protein excretions: non-nephrotic stage (14/24) and nephrotic stage (10/24). The patients were also categorized according to the etiology of amyloidosis; familial Mediterranean fever (FMF)-associated amyloidosis (15/24) versus rheumatoid disorders (RD)-associated amyloidosis (9/24). The changes of amount of proteinuria and estimated glomerular filtration rates were investigated after colchicine treatment started in these groups. Results: The mean follow-up period was 27.7 AE 19.2 months. After initiating colchicine therapy, the degree of proteinuria was decreased higher than 50% in 11/14 (78%) of non-nephrotic patients and elevated only in three (22%) patients. In nephrotic group, proteinuria was increased in 5/10 (50%) of patients. Glomerular filtration rates were stable in nephrotic and non-nephrotic groups. Presenting with nephrotic syndrome was higher in RD-associated amyloidosis (RD_A) group (5/9) than FMF-associated amyloidosis (FMF_A) group (5/15) without statistical significance (p40.05). After colchicine treatment, proteinuria was decreased in 12/15 patients in FMF_A group, however, the significant decreasing of proteinuria was not observed in RD_A group (p ¼ 0.05 vs. p40.05). Conclusion: Colchicine therapy was found more effective in low proteinuric stage of amyloidosis. The beneficial effect of colchicine therapy was not observed in patients with RD-associated amyloidosis.

Usefulness of Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio for Evaluation of Children with Familial Mediterranean Fever

“…The disease is common in Mediterranean countries, and the incidence of the disease has been reported as 1/200 in Ashkenazi Jews and 1/1000 in Turks [2]. Colchicine treatment has been shown to be effective in preventing the development of amyloidosis and in reducing proteinuria [3]. Subclinical inflammation can also be observed in FMF.…”

Colchicine as an anti-inflammatory and cardioprotective agent

“…Subsequent large cohort studies confirmed that colchicine efficacy in amyloidosis is limited to cases of inflammation-induced nephropathic amyloidosis without major cardiovascular involvement [81], and particularly to the early proteinuric stage of amyloidosis due to FMF [82]. Colchicine dose increase to 2.5 --3 mg/day can be guided by levels of SAA, the precursor protein of FMF-related amyloid substance, which is predominantly elevated in patients with family history of FMF, persistent proteinuria, M694V homozygosity and high CRP [83].…”

Long-term follow-up of secondary amyloidosis patients treated with tumor necrosis factor inhibitor therapy

“…[ 8 ] However, its beneficial effect in the other causes of AA amyloidosis is not clear. [ 9 ] In addition, case reports and small case series involving patients with FMF and other rheumatic diseases have reported some success with various immunosuppressives and immunomodulators such as azathioprine, [ 10 ] chlorambucil, [ 11 ] methotrexate, [ 12 ] interferon-alpha, [ 13 ] and cyclophosphamide. [ 14 ] In the last decade, biologic agents targeting proinflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1, and IL-6 have been tried in patients with AA amyloidosis.…”