1
|
Yildirim D, Kardas RC, Gun M, Kaya B, Vasi I, Duran R, Karadeniz H, Avanoglu Guler A, Kucuk H, Erden A, Goker B, Ozturk MA, Tufan A. Colchicine-intolerant familial mediterranean fever patients: A comparative study between different colchicine doses and IL-1 inhibitor monotherapy. Int Immunopharmacol 2024; 128:111491. [PMID: 38241844 DOI: 10.1016/j.intimp.2024.111491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Colchicine is the primary treatment for FMF, although some patients do not respond well or are unable to tolerate it. For these patients, the addition of interleukin-1 (IL-1) antagonists is the preferred option. However, the impact of colchicine treatment alongside the use of IL-1 antagonists remains unclear. METHODS We recruited adult FMF patients who satisfied the Eurofever and Pediatric Rheumatology International Trials Organization classification criteria and were receiving IL-1 antagonist treatment from our FMF cohort. All the patients exhibited colchicine intolerance or resistance. As per the FMF cohort protocol, the patients were longitudinally followed up, including assessments of their C-reactive protein, erythrocyte sedimentation rate, autoinflammatory disease activity index (AIDAI), and autoinflammatory damage index (ADDI). RESULTS Among the 125 patients (68 female and 57 male), 96 received a combination of IL-1 antagonists and the maximum tolerated dose of colchicine, whereas 29 were treated exclusively with IL-1 antagonists due to colchicine intolerance. The patients' inflammatory markers, AIDAI activity, and ADDI damage scores did not differ significantly between the two groups during the follow-up period. Notably, the drug retention rates were significantly higher in the patients treated solely with IL-1 antagonists. CONCLUSION While the typical approach is to maintain colchicine treatment alongside the use of IL-1 antagonists, for patients who cannot tolerate effective colchicine doses, IL-1 antagonists alone may effectively control FMF disease activity.
Collapse
Affiliation(s)
- Derya Yildirim
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey.
| | - Riza Can Kardas
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Mert Gun
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Burcugul Kaya
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Ibrahim Vasi
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Rahime Duran
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Hazan Karadeniz
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Aslihan Avanoglu Guler
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Hamit Kucuk
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Abdulsamet Erden
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Berna Goker
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Mehmet Akif Ozturk
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| | - Abdurrahman Tufan
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Turkey
| |
Collapse
|
2
|
Hausmann J, Dedeoglu F, Broderick L. Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Syndrome and Syndrome of Unexplained Recurrent Fevers in Children and Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1676-1687. [PMID: 36958521 DOI: 10.1016/j.jaip.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Children and adults with autoinflammatory disorders, who often experience recurrent fevers, rashes, cold-induced symptoms, conjunctivitis, lymphadenopathy, recurrent infections, aphthous stomatitis, and abnormal blood cell counts, may present to the allergist/immunologist because the symptoms mimic allergies and disorders of immunity. In recent years, there has been increased recognition of non-monogenic autoinflammatory disorders, including periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome and syndrome of undifferentiated recurrent fevers. For many clinical practitioners, the natural history, diagnostic criteria, differential diagnoses, and preferred therapies remain challenging because of the presumed rarity of patients and the evolving field of autoinflammation. Here, we aim to provide a practical framework for the clinical allergist/immunologist to evaluate and treat this patient population.
Collapse
Affiliation(s)
- Jonathan Hausmann
- Department of Medicine, Harvard Medical School, Boston, Mass; Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Fatma Dedeoglu
- Department of Medicine, Harvard Medical School, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Lori Broderick
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California-San Diego, La Jolla, Calif; Rady Children's Foundation, Rady Children's Hospital, San Diego, Calif.
| |
Collapse
|
3
|
Aiello A, Mariano EE, Prada M, Cioni L, Teruzzi C, Manna R. Budget impact analysis of anakinra in the treatment of familial Mediterranean fever in Italy. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2176091. [PMID: 36819891 PMCID: PMC9930828 DOI: 10.1080/20016689.2023.2176091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease that significantly reduces occupational productivity and quality-of-life in affected patients. Italy has an estimated FMF prevalence of 1 in 60,000 people. While colchicine is the primary treatment for FMF, biologics are administered to intolerant and non-responder patients. Anakinra and canakinumab are the only biologics approved and reimbursed for FMF in Italy. Both medicines have demonstrated efficacy in FMF patients yet differ in treatment costs. This study aimed to perform a budget impact analysis (BIA) following anakinra's reimbursement for FMF treatment, considering pharmaceutical costs from the Italian National Healthcare Service (NHS) perspective. METHODS A 'Reference scenario' (all patients treated with canakinumab) was compared to an 'Alternative scenario', with increased anakinra market shares. The target population was estimated based on the Italian population, epidemiological and market research data. Drugs costs were estimated based on Summary of Product Characteristics and net ex-factory prices. Sensitivity analyses were implemented to test results' robustness. RESULTS The base case analysis showed an overall cumulative expenditure of €30,586,628 for 'Reference scenario' and € 16,465,548 for 'Alternative scenario'. A cumulative savings of €14,121,080 (46.2%) was calculated over 3 years as a result of the reimbursement and increasing uptake of anakinra. The sensitivity analyses, even considering a discount of 50% for canakinumab, confirmed the base case results. CONCLUSIONS Anakinra's introduction, in FMF treatment, provides a financially sustainable option for Italian patients, with savings increasing according to greater use of anakinra.
Collapse
Affiliation(s)
- A Aiello
- Intexo Società Benefit S.r.l, Milan, Italy
| | - EE Mariano
- Intexo Società Benefit S.r.l, Milan, Italy
| | - M Prada
- Intexo Società Benefit S.r.l, Milan, Italy
| | - L Cioni
- Swedish Orphan Biovitrum, Milan, Italy
| | - C Teruzzi
- Swedish Orphan Biovitrum, Milan, Italy
| | - R Manna
- Periodic Fevers Research Centre, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
4
|
Yıldırım D, Vasi İ, Tahta E, Kardaş RC, Özkızıltaş B, Küçük H, Öztürk MA, Haznedaroğlu Ş, Göker B, Tufan A. Factors affecting patient-acceptable symptom states and treatment decision in familial Mediterranean fever. Turk J Med Sci 2022; 52:1991-1996. [PMID: 36945975 PMCID: PMC10390155 DOI: 10.55730/1300-0144.5547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Familial Mediterranean fever [FMF] is the most common autoinflammatory disease characterized by inflammatory attacks of fever and polyserositis. Patients' quality of life is significantly affected due to recurrent excruciating pain attacks and complications. This study is performed to evaluate the parameters most affecting patients' satisfaction from treatment. METHODS : Three hundred and forty-six consecutive patients diagnosed with FMF were enrolled in this study. Current treatment, acute phase proteins, number, type, and severity of predominant attacks, absenteeism from work/school in the last three months were recorded, and the participants were asked whether they needed additional treatment to evaluate Patient Acceptable Symptom State (PASS) status. RESULTS Mean age of the overall group was 38.2 ± 11.7 years (62.4% female, 37.6% male). Two hundred and twenty-seven patients were treated with colchicine, 97 patients with colchicine plus Interleukin-1 (IL-1) antagonist, and 22 only with IL-1 antagonist (67.1%, 26.3%, 6.64% in order). Of the overall group, 33.8% (n = 117) believed to need additional treatment options. Additional treatment need of patients was significantly affected by work impairment due to attacks, absent days from work, disease activity, the discomfort of patients during attacks, the number of attacks, and treatment options; but not by the level of acute-phase proteins between attacks. DISCUSSION PASS score is significantly related to clinical parameters and quality of life. Patients' PASS scores and treatment choices are notably affected by the severity and frequency of attacks and absenteeism from work/school. Clinical activity and quality of life should be evaluated at every visit to provide patients' satisfaction with treatment.
Collapse
Affiliation(s)
- Derya Yıldırım
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İbrahim Vasi
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Erdi Tahta
- Department of Internal Medicine, Abdurrahman Yurtaslan Education and Research Hospital, Ankara, Turkey
| | - Rıza Can Kardaş
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burcugül Özkızıltaş
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Şeminur Haznedaroğlu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Berna Göker
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|