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Colchicine may not be well tolerated by patients sometimes (Hentgen V, 2020). Intolerance is mostly caused by GI side effects, which might include diarrhoea or GI upset (Broderick L, 2022; Ben-Zvi, 2017).

As a result, some patients may indeed be unable to tolerate the required dose of colchicine (Hentgen V, 2020; Ben-Zvi, 2017). And then there are patients who are colchicine resistant. We believe that about three to five percent of FMF patients are colchicine-resistant (Batu ED, 2023). If you have a patient who is taking the maximum tolerated dose of colchicine with good compliance, but they experience no improvement of the frequency and severity of their attacks and or they have high acute phase reactants, you have to consider colchicine resistance (Bhatt H, 2023; Ozen S, 2016). A study of over 3,000 patients with paediatric FMF published last year has shown that there are some risk factors associated with colchicine resistance as well. And these were mainly the exon 10 mutations, younger age for symptom onset, and more frequent attacks (Batu ED, 2023). In patients who are colchicine-resistant or intolerant, according to the EULAR recommendations, the first recommended biologic agents are IL-1 inhibitors (Ozen S, 2016).