Effect of colchicine on the amyloidosis of familial Mediterranean fever

Daily administration of colchicine was suggested for the prevention of attacks of familial Mediterranean fever (FMF) in 1972 and its effectiveness was quickly proven. Evaluation of its effect on the amyloidosis of FMF required a much longer trial. Between 1973-1980 a total of 954 patients began daily prophylactic colchicine each patient has now been followed for four years or more. 114 were in various stages of overt amyloid nephropathy but 840 had no proteinuria and presumably were free of amyloidosis. Of the latter, 54 did not take the colchicine for a variety of reasons, and provided an unplanned control group of untreated patients. In the nonamyloidotic group, proteinuria appeared in three of the 786 compliant patients (18%). Among the amyloidotic patients, progression of nephropathy was slowed in those who started colchicine early in its course as compared to untreated patients, in our experience. These observations establish the efficacy of uninterrupted daily administration of colchicine both in preventing the development of amyloidosis due to FMF and in impeding its progression. We therefore prescribe colchicine in full dosage for all patients with FMF, regardless of whether their attacks remit or not, and even after kidney transplantation or during hemodialysis.