SAT0518 CANAKINUMAB TREATMENT IN ADULT PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: A SINGLE-CENTER STUDY
Authors: S. Ugurlu, B. H. Egeli, O. Selvi, B. Ergezen, A. Hadzalic, H. Ozdogan
Journal: Annals of the Rheumatic Diseases (2020)

Background: Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease characterized by recurrent, self-remitting attacks of fever, serositis, arthritis, and erysipelas-like erythema. Canakinumab is an Interleukin-1β inhibitor that is shown to be effective and safe in treating colchicine resistant FMF patients. Objectives: The main objective of this study is to present the single tertiary center experience of adult FMF patients who received Canakinumab. Methods: The study is a retrospective analysis conducted at a tertiary rheumatology center experienced in FMF. The patients who had a clinical diagnosis of FMF and who were treated with at least a single subcutaneous injection of canakinumab were included. Patients with amyloidosis and pregnancy were excluded. In order to evaluate the disease status, acute phase reactants and patient-reported disease severity visual analog scale (VAS) scores were analyzed. Acute phase reactants were evaluated during attack-free periods. The VAS score was reported on a scale of 0-10, 10 meaning the disease at its most severe form, and 0 meaning the least. Results: Fifty-two patients (21 male, 31 female) with the mean age of 35.88±12.4 years, were included in this study. The presenting signs and symptoms of the patients are shown in Figure 1. The mean age of initial symptoms and diagnosis were 12.84±10.06 and 20.39±12.35 years in respective order. The treatment information of the patients before and during Canakinumab injections was shown in Table 1. The mean Erythrocyte Sedimentation Rate (ESR) decreased from 25.31±20.64 to 11.52±9.78 mm/hour. The mean C-reactive Protein (CRP) decreased from 28.18±47.04 to 2.02±2.31 mg/L (both p&lt;0.0001). The mean VAS score decreased from 8.04±1.9 to 1.4±1.73 (p&lt;0.0001). Canakinumab treatment was terminated in 33 patients, 22 of which was due to successful remission. The termination of the treatment was because of pregnancy or will of pregnancy in 4 patients, inadequate treatment response 3 patients, treatment noncompliance in 2 patients, chronic hepatitis C related cirrhosis in 1 patient, and change to a different biologic agent in 1 patient. The only side effect experienced was hallucinations in one patient who was already under remission. Figure 1. The Presenting Signs and Symptoms of the Patients Table 1. The Treatment Information of the Patients Initial Mean Daily Colchicine Dose, mg (mean± standard deviation) 1.68±0.46 Mean Daily Colchicine Dose before Canakinumab Treatment, mg 1.63±0.6 The Mean Injection Number, n 17.5±17.8 Canakinumab Treatment Indication, n (%) Inadequate Response to Previous Treatment 38 (73.08) Side Effect to Previous Treatment 8 (15.38) Poly Arteritis Nodosa 2 (3.85) Recurrent Pericarditis 1 (1.92) CNS Vasculitis 2 (3.85) Poor Anakinra Treatment Adherence 1 (1.92) FMF Encephalopathy 1 (1.92) Conclusion: Canakinumab seems effective in controlling the subclinical inflammation and raising the quality of life of the patient. It has a favorable side effect profile. According to our single-center, real-life data, Canakinumab can be used as an alternative treatment method in colchicine resistant patients. Disclosure of Interests: None declared