Department of Internal Medicine, Division of Rheumatology, Yıldırım Doruk Hospital, Bursa, Turkey.
Department of Rheumatology, Ümraniye Training and Research Hospital, Istanbul, Turkey.
Rheumatol Int. 2022 Dec;42(12):2211-2219. doi: 10.1007/s00296-022-05199-w. Epub 2022 Sep 1.
This study aimed to investigate the disease characteristics of familial Mediterranean fever (FMF) patients undergoing dose optimisation and discontinuation of canakinumab therapy. A total of 61 patients diagnosed with FMF and using canakinumab for the resistant disease were enrolled on this retrospective study. Patients' characteristics, disease activity, treatment response, dose optimisation, dose intervals, attack-free periods, drug-free periods and side effects were noted. Dose intervals were extended in patients who achieved remission without being bound by any protocol at the discretion of the rheumatology physician who followed up with the patients in the outpatient clinic. The drug was discontinued in some patients whose dose intervals were 2 months or longer and remained in remission for 6 months or longer. A total of 57 patients (56% female, median age 32.4 years) were included. The mean attack frequency before canakinumab was 3.4/6 months, while it was 1.2 at the last post-treatment visit (p < 0.001). The median duration of canakinumab use was 46 months. After the first 6 months, the dosing interval was extended in 22 patients, and then treatment was discontinued in 12 of them who did not have an attack in the last 6 months. Three of the 12 patients whose treatment was discontinued started monthly treatment again after their attacks recurred. In the remaining ten patients, dose intervals were extended to 8-12 weeks after 6 months of monthly treatment. Nine patients are still being followed up without attacks and receive only colchicine therapy. Canakinumab is a safe and effective treatment, dose intervals may be extended, and follow-up without medication may be possible for eligible patients. However, there is a need for a consensus on dose optimisation or tapering.
本研究旨在探讨接受依那西普剂量优化和停药治疗的家族性地中海热（FMF）患者的疾病特征。这项回顾性研究共纳入了 61 名诊断为 FMF 且使用依那西普治疗难治性疾病的患者。记录了患者的特征、疾病活动度、治疗反应、剂量优化、剂量间隔、无发作期、无药期和副作用。在没有任何方案限制的情况下，达到缓解的患者可以延长剂量间隔，由随访门诊患者的风湿病医生酌情决定。一些剂量间隔为 2 个月或更长且缓解持续 6 个月或更长时间的患者停止了用药。共有 57 名患者（56%为女性，中位年龄 32.4 岁）入组。在依那西普治疗前，平均发作频率为 3.4/6 个月，而最后一次治疗后就诊时为 1.2 次（p<0.001）。依那西普的中位使用时间为 46 个月。在最初的 6 个月后，22 名患者延长了给药间隔，然后在其中 12 名在最后 6 个月内没有发作的患者中停止了治疗。在停止治疗的 12 名患者中，有 3 名在发作后又开始每月接受治疗。在其余 10 名患者中，在每月治疗 6 个月后，将剂量间隔延长至 8-12 周。9 名患者仍在随访中，没有发作，仅接受秋水仙碱治疗。依那西普是一种安全有效的治疗方法，可能延长剂量间隔，对于符合条件的患者，无需药物即可进行随访。但是，需要就剂量优化或逐渐减少达成共识。
