Familial mediterranean fever medical therapy: Difference between revisions
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(Updated to 2016 guidelines and two recent trials) |
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==Overview== | ==Overview== | ||
[[Clinical practice guideline]]s direct treatment<ref name="pmid26802180">{{cite journal| author=Ozen S, Demirkaya E, Erer B, Livneh A, Ben-Chetrit E, Giancane G et al.| title=EULAR recommendations for the management of familial Mediterranean fever. | journal=Ann Rheum Dis | year= 2016 | volume= 75 | issue= 4 | pages= 644-51 | pmid=26802180 | doi=10.1136/annrheumdis-2015-208690 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26802180 }} </ref>: | |||
03. "Treatment with [[colchicine]] should start as soon as a clinical diagnosis is made" | |||
17. "In protracted febrile myalgia, [[glucocorticoid]]s lead to the resolution of symptoms; NSAID and [[Interleukin_1|IL-1]]-blockade might also be a treatment option; NSAIDs are suggested for the treatment of exertional leg pain" | |||
==IL-1-blockade with anakinra== | |||
A [[systematic review]] of [[Interleukin_1|IL-1]] blockade with [[anakinra]], [[canakinumab]], and [[rilonacept]] found only one randomized controlled trial.<ref name="pmid27110096">{{cite journal| author=van der Hilst JCh, Moutschen M, Messiaen PE, Lauwerys BR, Vanderschueren S| title=Efficacy of anti-IL-1 treatment in familial Mediterranean fever: a systematic review of the literature. | journal=Biologics | year= 2016 | volume= 10 | issue= | pages= 75-80 | pmid=27110096 | doi=10.2147/BTT.S102954 | pmc=4831592 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27110096 }} </ref> | |||
* [[anakinra]]: benefit in one small, [[randomized controlled trial]] in which the median number of attacks per month dropped from 3.5 with placebo to 1.7 with anakinra.<ref name="pmid27860460">{{cite journal| author=Ben-Zvi I, Kukuy O, Giat E, Pras E, Feld O, Kivity S et al.| title=Anakinra for Colchicine-Resistant Familial Mediterranean Fever: A Randomized, Double-Blind, Placebo-Controlled Trial. | journal=Arthritis Rheumatol | year= 2017 | volume= 69 | issue= 4 | pages= 854-862 | pmid=27860460 | doi=10.1002/art.39995 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27860460 }} </ref> | |||
* [[canakinumab]]: no randomized controlled trials. | |||
* [[rilonacept]]: benefit in one small, [[randomized controlled trial]] in which the median number of attacks per month dropped from 2 with placebo to 0.77 with rilonacept.<ref name="pmid23070486">{{cite journal| author=Hashkes PJ, Spalding SJ, Giannini EH, Huang B, Johnson A, Park G et al.| title=Rilonacept for colchicine-resistant or -intolerant familial Mediterranean fever: a randomized trial. | journal=Ann Intern Med | year= 2012 | volume= 157 | issue= 8 | pages= 533-41 | pmid=23070486 | doi=10.7326/0003-4819-157-8-201210160-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23070486 }} </ref> | |||
==References== | ==References== | ||
Revision as of 02:19, 21 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Clinical practice guidelines direct treatment[1]:
03. "Treatment with colchicine should start as soon as a clinical diagnosis is made"
17. "In protracted febrile myalgia, glucocorticoids lead to the resolution of symptoms; NSAID and IL-1-blockade might also be a treatment option; NSAIDs are suggested for the treatment of exertional leg pain"
IL-1-blockade with anakinra
A systematic review of IL-1 blockade with anakinra, canakinumab, and rilonacept found only one randomized controlled trial.[2]
- anakinra: benefit in one small, randomized controlled trial in which the median number of attacks per month dropped from 3.5 with placebo to 1.7 with anakinra.[3]
- canakinumab: no randomized controlled trials.
- rilonacept: benefit in one small, randomized controlled trial in which the median number of attacks per month dropped from 2 with placebo to 0.77 with rilonacept.[4]
References
- ↑ Ozen S, Demirkaya E, Erer B, Livneh A, Ben-Chetrit E, Giancane G; et al. (2016). "EULAR recommendations for the management of familial Mediterranean fever". Ann Rheum Dis. 75 (4): 644–51. doi:10.1136/annrheumdis-2015-208690. PMID 26802180.
- ↑ van der Hilst JCh, Moutschen M, Messiaen PE, Lauwerys BR, Vanderschueren S (2016). "Efficacy of anti-IL-1 treatment in familial Mediterranean fever: a systematic review of the literature". Biologics. 10: 75–80. doi:10.2147/BTT.S102954. PMC 4831592. PMID 27110096.
- ↑ Ben-Zvi I, Kukuy O, Giat E, Pras E, Feld O, Kivity S; et al. (2017). "Anakinra for Colchicine-Resistant Familial Mediterranean Fever: A Randomized, Double-Blind, Placebo-Controlled Trial". Arthritis Rheumatol. 69 (4): 854–862. doi:10.1002/art.39995. PMID 27860460.
- ↑ Hashkes PJ, Spalding SJ, Giannini EH, Huang B, Johnson A, Park G; et al. (2012). "Rilonacept for colchicine-resistant or -intolerant familial Mediterranean fever: a randomized trial". Ann Intern Med. 157 (8): 533–41. doi:10.7326/0003-4819-157-8-201210160-00003. PMID 23070486.