Colchicine intolerance in FMF patients and primary obstacles for optimal dosing
Open Access
- 1 January 2020
- journal article
- research article
- Published by The Scientific and Technological Research Council of Turkey (TUBITAK-ULAKBIM) - DIGITAL COMMONS JOURNALS in TURKISH JOURNAL OF MEDICAL SCIENCES
- Vol. 50 (5), 1337-1343
- https://doi.org/10.3906/sag-2001-261
Abstract
Background/aim: Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in a substantial number of patients due to its side effects. In this study, we aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and cause permanent discontinuation. Materials and methods: All patients were recruited from "FMF in Central Anatolia" (FiCA) cohort, 915 adults with a minimum follow-up time of 6 months during which they had obeyed all treatment instructions. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications, and treatment features were recorded on a web-based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed. Results: Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows: diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in five (0.5%), and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male sex and obesity were found to be associated with liver toxicity, and having a normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine-intolerant patients, and they had reported more frequent attacks compared to those tolerating optimal doses. Conclusion: Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing is associated with complications.Keywords
This publication has 29 references indexed in Scilit:
- Chronic inflammation in FMF: markers, risk factors, outcomes and therapyNature Reviews Rheumatology, 2010
- Colchicine poisoning: the dark side of an ancient drugClinical Toxicology, 2010
- The Effects of Long-term Colchicine Therapy on Male Fertility in Patients with Familial Mediterranean FeverAndrologia, 2009
- Familial Mediterranean Fever (FMF) in TurkeyMedicine, 2005
- Sex is a major determinant of CYP3A4 expression in human liverHepatology, 2003
- Acute phase response in familial Mediterranean feverAnnals Of The Rheumatic Diseases, 2002
- Criteria for the diagnosis of familial mediterranean feverArthritis & Rheumatism, 1997
- Colchicine in the Prevention and Treatment of the Amyloidosis of Familial Mediterranean FeverThe New England Journal of Medicine, 1986
- Gastrointestinal effects of long-term colchicine therapy in patients with recurrent polyserositis (familial Mediterranean fever)Digestive Diseases and Sciences, 1982
- A Controlled Trial of Colchicine in Preventing Attacks of Familial Mediterranean FeverThe New England Journal of Medicine, 1974