This is Familial
Mediterranean Fever
(FMF)

FMF is an autoinflammatory disorder associated with mutations in the MEVF gene leading to overproduction of interleukin-1β (IL-1β)1

FMF is the most common inherited monogenic autoinflammatory disease and affects mainly ethnic groups from the eastern Mediterranean area. However, due to worldwide migration, FMF is also found beyond mediterranean countries and even in populations with no recent ancestry to mediterranean countries. FMF is one of the periodic fever syndromes.2-5

for illustrative purposes only - region around the mediterranean sea

FMF is almost always restricted to Turks, Armenians, Arabs, and non-Ashkenazi Jews4,6

  • Turkey - Probably the country with the highest prevalence, Estimated prevalence: 1:400 to 1:1,000 (highest in the areas of Anatolia). >100,000 FMF patients in total4
  • Armenia - Prevalence estimated to 1:500, 6,000 in total4
  • Germany - Most FMF patients are from Turkish origin4
  • France - Prevalence 1:5,000, Total: 5-10,000 patients, Most FMF patients from North African origin4,7
  • Greece, Cyprus - 1:25 Greek-Cypriots is a carrier of one of the three most common mutations in MEFV8
  • Japan - ~100 patients4
  • Jordan, Syria, and Lebanon- many FMF patients but exact number not known4
  • Israel - Prevalence 1:1,000 (depending on ethnic group)4
  • Italy - No longer a rare disease. More patients in central and southern parts4,9

In patients with FMF, mutations in the MEFV gene encoding for pyrin leads to malfunctioning of the pyrin inflammasome and overproduction of interleukin-1 (IL-1β).10 FMF is characterised by recurrent, self-limited episodes of fever accompanied by inflammation and serositis. Abdominal pain is a common feature during febrile attacks, and chest pain, myalgia and rash can also be present. FMF often begins in childhood or adolescence, and the frequency and severity of attacks can vary widely between individuals.4,5,11 FMF is diagnosed clinically but can be supported but not excluded by genetic testing.4

A severe complication of FMF is the development of secondary amyloidosis (AA amyloidosis*), which is the result of prolonged and uncontrolled inflammation and can ultimately lead to renal failure.12

common symptoms

Common signs and symptoms associated with FMF4,13,14

efficacy in familial mediterranean fever

A valuable asset for the treatment of FMF

The goals of treatment in FMF are to prevent acute attacks, minimise subclinical inflammation in between attacks, and prevent the development and progression of amyloidosis.12

Adding an IL-1 inhibitor like Kineret may be an alternative for patients who do not respond to or cannot tolerate colchicine. In a systemic literature review, complete response to therapy without a single attack during treatment was reported in 76.5% of patients on anakinra treatment.15 Patients also experienced a decrease of proteinuria after initiating Kineret.15

In the randomised controlled trial “Anakinra for Colchicine-Resistant Familial Mediterranean Fever”, Kineret had a favorable efficacy and safety profile in patients who failed to reach their treatment goals with colchicine.

Adding Kineret reduced the number of attacks per month and significantly improved patients' QoL scores1,16

Adapted from: Table 2, Ben-Zvi et al. 2017. Anakinra for Colchicine-Resistant Familial Mediterranean Fever.

Patients who achieved improvement with Kineret16

Adapted from: Figure 3, Ben-Zvi et al. 2017. Anakinra for Colchicine-Resistant Familial Mediterranean Fever

The proportion of patients who experienced improvement with either Kineret or placebo treatment was assessed using the modified familial Mediterranean fever 50% improvement (FMF50) score. Improvement percentages in each group were determined based on meeting at least three out of four criteria: a reduction of at least 50% in the total number of attacks, the number of joint attacks, C-reactive protein (CRP) and serum amyloid A (SAA) levels (or reaching normal values, defined as ≤5 mg/liter for CRP and ≤10 mg/liter for SAA), and quality of life rating.16

* AA Amyloidosis can occur as a response to a chronic inflammatory disease or infection. These conditions cause the liver to produce high levels of a protein called serum amyloid A (SAA), which may form abnormal fibril protein aggregates in tissues and organs, leading to AA amyloidosis.

Abbreviations

MEFV, Mediterranean Fever (MEditteranean FeVer gene); FMF50 score required improvement by ≥50% in five of six criteria (attack frequency, attack duration, global patient assessment, global physician assessment, frequency of attackswitharthritis,andlevelsofacute-phasereactants)withoutworseningofthesixthcriterion; CRP,C-reactive protein; SAA, serum amyloid A; QoL, Quality of life; IL-1, Interleukin-1; IL-1β, Interleukin-1 beta

Kineret Q&A

How is Kineret administered?
  • Kineret is given in a pre-filled syringe containing 100 mg of anakinra per 0.67 ml (150 mg/ml).1
  • Kineret is given as a subcutaneous injection.1
  • Dosage depends on indication. In children, the dose is determined depending on body weight. Please refer to current SmPC.
How should Kineret be stored?
  • Kineret should be stored in a refrigerator between 2°C and 8°C.1
  • Kineret should not be frozen or shaken.1
  • Kineret should be kept in its original carton and away from light.1

References

  • Swedish Orphan Biovitrum AB (publ). Kineret summary of product characteristics [SmPC]. Latest version available from: https:// www.ema.europa.eu/en/documents/product-information/kineret-epar-product-information_en.pdf
  • Özen S, Batu ED, Demir S. Familial Mediterranean Fever: Recent Developments in Pathogenesis and New Recommendations for Management. Front Immunol. 2017 Mar 23;8:253. doi: 10.3389/fimmu.2017.00253. PMID: 28386255; PMCID: PMC5362626.
  • Manna R, Rigante D. Familial Mediterranean Fever: Assessing the Overall Clinical Impact and Formulating Treatment Plans. Mediterr J Hematol Infect Dis. 2019 May 1;11(1):e2019027. doi: 10.4084/MJHID.2019.027.
  • Ben-Chetrit E, Touitou I. Familial mediterranean Fever in the world. Arthritis Rheum. 2009 Oct 15;61(10):1447-53. doi: 10.1002/ art.24458. PMID: 19790133.
  • Lidar M, Livneh A. Familial Mediterranean fever: clinical, molecular and management advancements. Neth J Med. 2007 Oct;65(9):318-24. PMID: 17954950.
  • Hashkes PJ., Laxer RM. and Simon A. Textbook of Autoinflammation. Chapter on FMF by Padeh S. et al. Springer 2019
  • PNDS. Fièvre Méditerranéenne Familiale (FMF).Centre de référence des maladies auto-inflammatoires de l’enfant. ; 2013.
  • Deltas CC, Mean R, Rossou E, Costi C, Koupepidou P, Hadjiyanni I, Hadjiroussos V, Petrou P, Pierides A, Lamnisou K, Koptides M. Familial Mediterranean fever (FMF) mutations occur frequently in the Greek-Cypriot population of Cyprus. Genet Test. 2002 Spring;6(1):15-21. doi: 10.1089/109065702760093861. PMID: 12180071.
  • La Regina M, Nucera G, Diaco M, Procopio A, Gasbarrini G, Notarnicola C, Kone-Paut I, Touitou I, Manna R. Familial Mediterranean fever is no longer a rare disease in Italy. Eur J Hum Genet. 2003 Jan;11(1):50-6. doi: 10.1038/sj.ejhg.5200916. PMID: 12529705.
  • La Bella S, Di Ludovico A, Di Donato G, Basaran O, Ozen S, Gattorno M, Chiarelli F, Breda L. The pyrin inflammasome, a leading actor in pediatric autoinflammatory diseases. Front Immunol. 2024 Jan 5;14:1341680. doi: 10.3389/fimmu.2023.1341680. PMID: 38250061; PMCID: PMC10796709.
  • Bhatt H, Cascella M. Familial Mediterranean Fever. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809589.
  • Ozen S, Demirkaya E, Erer B, Livneh A, Ben-Chetrit E, Giancane G, Ozdogan H, Abu I, Gattorno M, Hawkins PN, Yuce S, Kallinich T, Bilginer Y, Kastner D, Carmona L. EULAR recommendations for the management of familial Mediterranean fever. Ann Rheum Dis. 2016 Apr;75(4):644-51. doi: 10.1136/annrheumdis-2015-208690. Epub 2016 Jan 22. PMID: 26802180.
  • Ozdogan H, Ugurlu S. Familial Mediterranean Fever. Presse Med. 2019 Feb;48(1 Pt 2):e61-e76. doi: 10.1016/j.lpm.2018.08.014. Epub 2019 Jan 25. PMID: 30686512
  • Breuer GS, Taurog JD. Erysipelas-like erythema in a patient with familial Mediterranean fever. J Rheumatol. 2014 Nov;41(11):2271- 2. doi: 10.3899/jrheum.140324. PMID: 25362709.
  • van der Hilst JCh, Moutschen M, Messiaen PE, Lauwerys BR, Vanderschueren S. Efficacy of anti-IL-1 treatment in familial Mediterranean fever: a systematic review of the literature. Biologics. 2016 Apr 4;10:75-80. doi: 10.2147/BTT.S102954. PMID: 27110096; PMCID: PMC4831592.
  • Ben-Zvi I, Kukuy O, Giat E, Pras E, Feld O, Kivity S, Perski O, Bornstein G, Grossman C, Harari G, Lidar M, Livneh A. Anakinra for Colchicine-Resistant Familial Mediterranean Fever: A Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol. 2017 Apr;69(4):854-862. doi: 10.1002/art.39995. PMID: 27860460.