The updated EULAR and PReS-endorsed recommendations for the management of Familial Mediterranean Fever (FMF) propose a therapeutic algorithm where IL-1 inhibitors such as Kineret (anakinra) are the preferred additional therapies in patients with an inadequate response to colchicine.1
A critical aspect of IL-1 inhibitors is their ability to control subclinical inflammation in patients with colchicine-resistant FMF. This is essential for preventing severe complications such as AA amyloidosis, a potentially life-threatening condition characterized by deposition of inflammatory proteins in various organs.1
Although colchicine remains the first-line treatment for FMF, a subset of patients fails to achieve adequate response despite maximum tolerated doses. In these patients, IL-1 inhibitors may be used as an addition to colchicine to enhance disease control when standard therapy is insufficient.1
Colchicine resistance is defined by recurrent clinical attacks (average ≥1 attacks per month over a 3-month period) or persistently elevated serum CRP or SAA in between attacks in the absence of any other plausible explanation.1
Management of FMF requires a holistic approach, integrating both pharmacological and non‑pharmacological strategies, with the aim of supporting patients’ health‑related quality of life and daily functioning.1
Regular monitoring is an essential component of FMF management. According to current recommendations, response, toxicity, and adherence should be assessed regularly—more frequently at diagnosis and when the disease is not controlled. For patients treated with biologic agents, treatment doses should be optimised, and in cases of sustained remission, tapering may be considered with close follow‑up. This structured approach aims to support safe and effective long‑term disease control.1
Kineret, approved in Europe for the treatment of FMF in 2020, remains an established treatment option for patients with colchicine-resistant FMF due to the high level of evidence supporting its efficacy and safety.2
Abbreviations
IL-1, Interleukin 1; FMF, Familial Mediterranean Fever; CRP, C-reactive protein; SAA, serum amyloid A