Association between colchicine resistance and vitamin D in familial Mediterranean fever

Abstract

Although colchicines are the only effective treatment of familial Mediterranean fever (FMF), resistance to colchicines (CR) which is observed in up to 30% of the patients is still a problem. Clinically, resistance to colchicine is defined as three or more attacks within the last 6 months period while using ≥2 mg/day colchicine. Previous studies have shown decreased vitamin D levels in FMF patients compared with healthy controls. The aim of this study is to evaluate whether vitamin D levels differ between CR and non-CR FMF patients. This study included 64 FMF patients who were being followed in Nephrology Clinic of Samsun Research and Education Hospital for at least 1 year. FMF was diagnosed according to the criteria defined by Livneh et al. Serum 25-hydroxy vitamin D (25-OHD) concentration (ng/mL) was detected in all FMF patients who were not in an acute attack period. From 64 patients 29 were accepted as CR. Mean 25-OHD level was 9.39 ± 1.00 ng/mL in CR patients and 18.48 ± 1.09 ng/mL in colchicine responsive patients (p < 0.001). Plasma vitamin D levels were significantly lower in colchicine resistant patients. Vitamin D deficiency may be a factor in etiopathogenesis of CR. Studies in larger patient samples that particularly evaluate the response to vitamin D replacement in CR FMF patients are needed.

Colchicine resistance and low vitamin D in familial Mediterranean fever

“…Karatay et al 3 reported low vitamin D levels in patients with Behcet's disease and also demonstrated a strong relationship between colchicine use and low serum vitamin D levels as in our study. Similarly, Ö zer et al 1 reported a significantly higher mean colchicine dose in resistant patients, in whom lower vitamin D levels were observed. To date, the exact mechanism of colchicine is unknown.…”

“…We read with interest the study by Ö zer et al 1 evaluating the association between colchicine resistance and vitamin D levels in familial Mediterranean fever (FMF).…”

Introducing variability in targeting the microtubules: Review of current mechanisms and future directions in colchicine therapy

“…90 Vitamin D deficiency in FMFwas proposed to contribute to the lack of response to colchicine. 87 Blood group A had 1.5-fold higher incidence of FMF and a better response to colchicine treatment than the non-A blood group, while patients in the O blood group prominently exhibited colchicine resistance. 91 Cellular transport of colchicine is mediated by the P-glycoprotein (P-gp) efflux pump encoded by the multiple drug resistance-1 gene.…”

“…Despite regular use, 10%-30% of patients with FMF do not respond to colchicine, even when used at the highest tolerable dose. [83][84][85][86][87] There is no standard, validated definition for colchicine resistance, and proper definitions for attack-free periods and persistence of high acute phase reactants are still lacking. 85 Colchicine does not exert an immediate effect when administered during an acute attack of FMF, suggesting that higher concentrations and prolonged treatment periods may be required for to achieve an effect on neutrophil function and for a resulting therapeutic effect.…”

Ergebnisse der systematischen Literatursuche als Grundlage für die „evidenzbasierten Therapieempfehlungen für FMF-Patienten mit unzureichendem Ansprechen bzw. Unverträglichkeit auf Kolchizin“ der Gesellschaft für Kinder- und Jugendrheumatologie und der Deutschen Gesellschaft für Rheumatologie

“…[ 44 ] 2017 ≥1 Attacke/Monat über 3 Monate Ozer, I. et al. [ 45 ] 2015 ≥3 Attacken in 6 Monaten Ozkan, S. et al. [ 46 ] 2017 Schwere, häufige Attacken und/oder erhöhte Entzündungsparameter Pecher, A.C. et al.…”