Efficacy and safety of anti-interleukin-6 treatment in familial Mediterranean
fever: a systematic literature review
#MMPMID41347104
Saidane O
; Bouden S
; Jerbi A
; Rouached L
; Mahmoud I
; Tekaya R
; Tekaya AB
; Abdelmoula L
Reumatologia
2025[]; 63
(5
): 337-347
PMID41347104
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INTRODUCTION: Biological treatments are indicated in familial Mediterranean fever
(FMF) patients with colchicine resistance or intolerance. Interleukin-1 (IL-1)
inhibitors may not yield sufficient efficacy and safety. Interleukin-6 inhibitors
(tocilizumab - TCZ) have been suggested to be potentially beneficial. This
systematic literature review aimed to evaluate the existing data on the efficacy
and safety of IL-6 inhibitors in the treatment of FMF. MATERIAL AND METHODS: A
systematic literature review was conducted using PubMed, Embase, Scopus, Web of
Science, and the Cochrane Library to identify literature published until February
2024 on "Tocilizumab" OR "Interleukin-6 inhibitor" AND "Familial Mediterranean
Fever". This study was conducted according to PRISMA (Preferred Reporting Items
for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: A total of 11
studies were included, corresponding to 68 patients: 6 studies were case reports,
3 were case series, and 2 were randomized control trials. Tocilizumab was
indicated mainly for amyloid A (AA) amyloidosis and resistance/intolerance to
other drugs. Tocilizumab showed efficacy in controlling FMF attacks and disease
symptoms including fever, abdominal pain, arthritis and arthralgia. Inflammatory
markers including C-reactive protein and serum amyloid A protein decreased. A
decrease in proteinuria levels was reported in 20 patients. Adverse events were
recorded in one-third of patients and led to TCZ discontinuation in 5 patients.
No deaths associated with anti-IL-6 treatment were documented within a median
follow-up period of 13 months. CONCLUSIONS: Although the duration of follow-up of
TCZ was short, we concluded that TCZ might present an acceptable profile
regarding efficacy and safety in adult FMF patients. Our data suggest that TCZ
could be a good treatment option after IL-1 inhibitors and warrants further
investigation.
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