Ailesel Akdeniz Ateşi Hastalarında Biyolojik Ajanlara Geçmeden Önce Kolşisinin Farklı Farmasötik Preparatları Alternatif Bir Tedavi Seçeneği Olabilir

Öz

Kolşisin, Ailesel Akdeniz Ateşi (FMF) tedavisinin temelini oluşturur. Ülkemizde, yerli film kaplı veya şeker kaplı kolşisin tabletlerinin etkisiz kaldığı veya yan etkiler gösterdiği durumlarda, biyolojik tedavilere geçilmeden önce genellikle ithal sıkıştırılmış kolşisin tabletleri kullanılmaktadır. Çalışmamızda, Türk FMF hastalarında tedavi etkinliği ve yan etki sıklığı açısından farklı kolşisin formülasyonlarını karşılaştırmayı amaçladık. Çalışmamıza, tek bir merkez olarak Uludağ Üniversitesi Tıp Fakültesi romatoloji polikliniğinde Ocak 2016 ile Aralık 2019 tarihleri arasında takip edilen, yerli şeker veya film kaplı kolşisin preparatı kullanımı sırasında direnç veya yan etkiler nedeniyle ithal sıkıştırılmış kolşisin tabletlerine geçirilmiş 75 Türk yetişkin FMF hastası dahil edildi. Hastaların dosyalarına hastane veri tabanından retrospektif olarak erişildi. Farmasötik preparat değişikliğinin nedeni hastaların %84'ünde dirençti ve ilaç değişikliğinden sonra direnç oranı %17,3'e düştü. Tedavi değişikliğinden sonra, yıllık medyan atak sıklığı ve süresi, ataksız dönemde medyan C-reaktif protein ve eritrosit sedimantasyon hızı, önceki duruma kıyasla azalmıştır ve tüm değişiklikler istatistiksel olarak anlamlıdır (p<0,001). Hastaların %29,3'ünde yan etkiler nedeniyle preparat değiştirildi ve ilaç değişikliğinden sonra yan etki oranı %5,3 azaldı (p<0,001). Yurt içinde üretilen kaplı kolşisin tabletlerine direnç gösteren veya yan etkiler nedeniyle bu tabletleri kullanamayan FMF hastaları, ithal sıkıştırılmış kolşisin tabletlerinden fayda görebilir. Bu nedenle, biyolojik tedavilere geçmeden önce ithal sıkıştırılmış kolşisin seçeneği göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Ailevi Akdeniz Ateşi.
• Direnç.
• Kolşisin.
• Sıkıştırılmış kolşisin

Different Pharmaceutical Preparations of Colchicine can be an Alternative Treatment Before Switching to Biological Agents in Patients with Familial Mediterranean Fever

Öz

Colchicine is the mainstay of treatment of Familial Mediterranean Fever (FMF). In Türkiye, imported compressed colchicine tablets are commonly used before switching to biological treatments in cases where domestic film or sugar-coated colchicine tablets are ineffective or have adverse effects. We aimed to compare different pharmaceutical preparations of colchicine in terms of treatment efficacy and frequency of adverse effects in Turkish FMF patients. Our study included 75 Turkish adult FMF patients followed at the Bursa Uludağ University Faculty of Medicine rheumatology outpatient clinic serving as a single center between January 2016 and December 2019, who were switched from domestic sugar- or film-coated colchicine preparations to imported compressed colchicine tablets due to resistance or adverse effects. Our study included 75 Turkish adult FMF patients followed up in a single center, who were switched to imported compressed colchicine tablets due to resistance or adverse effects while using a sugar or film-coated domestic colchicine preparation. Patient files were accessed retrospectively from the hospital database. The change in pharmaceutical preparation was due to resistance in 84% of patients, and the post-change resistance rate decreased to 17.3%. After the treatment change, the annual median attack frequency and duration, the median C-reactive protein and erythrocyte sedimentation rate in the attack-free period decreased compared to before, and all changes were statistically significant (p<0.001). The preparation was changed due to adverse effects in 29.3% of patients, and the adverse effect rate decreased by 5.3% after the drug change (p<0.001). FMF patients who are resistant to domestically produced coated colchicine tablets or cannot use them due to adverse effects may benefit from imported compressed colchicine tablets. Therefore, the option of imported compressed colchicine should be kept in mind before switching to biological treatments.

Anahtar Kelimeler

• Colchicine.
• Compressed colchicine.
• Familial Mediterranean Fever.
• Resistance.

Kaynakça

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