gms | German Medical Science

Introduction: Colchicine is the mainstay treatment of many autoinflammatory diseases especially of FMF. It is generally accepted as a cheap, safe and effective treatment; however, colchicine intolerance (CI) is a frequent problem in daily practice. Although CI is usually not persistent, it may prevent reaching effective dosage in a substantial number of patients causing decreased quality of life. In pediatric practice there are many unknowns on the definition, prevalence and risk factors of CI. In this study, we aimed to characterize the frequency and characteristics of CI in our center and to improve our daily practice with this frequent problem.

Methods: This is a single center longitudinal study recruiting all the children (0–18 years) who were treated with colchicine at least 6 months. CI was defined according to Ozen et al. [1].

Results: A total of 194 patients included in this study. The patient characteristics: Overall 50 (25,8%) of patients had CI: 37 (74%) gastrointestinal symptoms with 37 abdominal pain, 36 (72%) diarrhea, 12 (24%) liver toxicity, 1 myopathy. 34% of the patients had transient symptoms which improve with lactose-free diet or transient pause of the drug, however 66% of patients with CI had persistent symptoms (more than 3 months) and colchicine preparate was changed (60%). Colchicine should be stopped in 9 patients and among them 6 patients needed biologics. It is noteworthy that 5/12 patients with liver toxicity had obesity as a comorbidity. Patients who are diagnosed less than 4 years of age have significantly more colchicine intolerance compared to patients who were diagnosed more than 4 years of age (p 0,013). There was no significant difference according to disease groups; 29,6% of FMF, 23,2% PFAPA and 30,8% of CAPS patients were colchicine intolerant.

Conclusion: In this single center study CI was observed in 25,8% of patients, much higher to previous studies in adults and children. Further studies should be planned to decipher the pathogenesis and management of CI.