The efficacy of interleukin‐1 antagonist drugs in combination with colchicine in patients with FMF‐AA with colchicine resistance after kidney transplantation: A study with histopathologic evidence

Background The efficacy of anti‐interleukin‐1 (IL‐1) drugs in kidney transplant patients with FMF‐AA who developed colchicine resistance has not been clearly demonstrated. Method Thirty nine kidney transplant recipients with FMF‐AA were evaluated. Group 1 consisted of patients who were in remission after transplantation with colchine and Group 2 included those who developed colchicine resistance. Results The mean follow‐up of the patients was 88.5 ± 61.9 months. Following the treatment with IL‐1 antagonists; serum Amyloid A (SAA) averages (79.4 ± 35.3 mg/L) as well as the average number of hospitalizations per month due to FMF episodes (1.4 ± 0.5 times/month) decreased significantly (26.6 ± 25.9 mg/L and 0.1 ± 0.3 times/month) ( p  < .001). Rates of death with a functional graft were 30% and 0% in group 1 and 2 ( p  = .086). Biopsy‐proven AA amyloidosis recurrence in the allograft was observed in 11 of 19 (58%) and seven of nine (78%) patients in group 1 and 2, respectively. Interestingly, glomerular amyloid deposition was not present in the vast majority of biopsies. De novo vasculer amyloid deposition was observed during treatment. Conclusion IL‐1 antagonist drug and colchicine combination almost completely prevented acute FMF attacks in kidney transplant patients with colchicine resistance. However, amyloid accumulation did not cease during IL‐1 antagonist drug treatment.