Efficacy of anti-IL-1 treatment in familial Mediterranean fever: a systematic review of the literature

Introduction: In 5%-10% of patients with familial Mediterranean fever (FMF), colchicine is not effective in preventing inflammatory attacks. Another 5%-10% of patients are intolerant to effective doses of colchicine and experience serious side effects. Treatment with anti-interleukin-1 (IL-1) drugs may be an alternative for these patients, although it is not reimbursed for this indication in many countries. Methods: We systematically searched PubMed, Web of Science, and Scopus for reports of anti-IL-1 treatment in FMF patients. Results: Out of 284 potentially relevant articles, 27 eligible reports were identified and included in the data analysis. Conclusion: A complete response to therapy without a single attack during treatment was reported in 76.5% of patients on anakinra treatment and in 67.5% of patients during canakinumab treatment. In patients with established type AA amyloidosis, anti-IL-1 treatment can reverse proteinuria. Anti-IL-1 therapy seems to be a safe and effective alternative for patients with FMF who do not respond to or cannot tolerate colchicine.