Update on the management of colchicine resistant Familial Mediterranean Fever (FMF)

Orphanet J Rare Dis. 2019 Oct 15;14(1):224. doi: 10.1186/s13023-019-1201-7.


Background: Familial Mediterranean Fever (FMF), an autoinflammatory disease, is characterized by self-limited inflammatory attacks of fever and polyserositis along with high acute phase response. Although colchicine remains the mainstay in treatment, intolerance and resistance in a certain portion of patients have been posing a problem for physicians.

Main body: Like many autoimmune and autoinflammatory diseases, many colchicine-resistant or intolerant FMF cases have been successfully treated with biologics. In addition, many studies have tested the efficacy of biologics in treating FMF manifestations.

Conclusion: Since carriers of FMF show significantly elevated levels of serum TNF alpha, IL-1, and IL-6, FMF patients who failed colchicine were successfully treated with anti IL-1, anti IL-6, or TNF inhibitors drugs. It is best to use colchicine in combination with biologics.

Keywords: Autoinflammatory diseases; Biologics; Colchicine resistance; Familial Mediterranean fever.

Publication types

  • Review

MeSH terms

  • Animals
  • Colchicine / therapeutic use*
  • Familial Mediterranean Fever / blood
  • Familial Mediterranean Fever / drug therapy*
  • Humans
  • Interleukin-1 / blood
  • Interleukin-6 / blood
  • Tumor Necrosis Factor-alpha / blood


  • Interleukin-1
  • Interleukin-6
  • Tumor Necrosis Factor-alpha
  • Colchicine