s34_ab7

The effect of interferon alpha administration on acute attacks of familial Mediterranean fever: A double-blind, placebo-controlled trial

M. Tunca¹, S. Akar¹, M. Soytürk¹, G. Kirkali², H. Resmi², H. Akhunlar², Ö. Gönen¹, J.R. Gallimore³, P.N. Hawkins³, E. Tankurt¹

Dokuz Eylül University School of Medicine, ¹Department of Internal Medicine1 and 2Department of Biochemistry², Izmir, Turkey and ³Centre for Amyloidosis and Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, London, UK.

ABSTRACT
Background
About a quarter of familial Mediterranean fever (FMF) patients are partially or totally resistant to colchicine. A previous observation reported that acute attacks may be shortened by administration of interferon alpha (IFN).

Objective
We designed a double-blind, placebo-controlled trial to test our initial observations of a beneficial response with IFN in FMF attacks.

Methods
We treated 34 acute abdominal attacks with IFN 5 million IU or placebo sc in the early phase of the attack. Leucocytes, thrombocytes, the erythrocyte sedimentation rate, fibrinogen, C-reactive protein (CRP), serum amyloid A protein (SAA), haptoglobin, transferrin, IL-1b and TNF-a were measured at hours 0, 6, 12, 24 and 48.

Results
The median time to recovery in those treated with IFN and placebo was not significantly different, while the leucocytosis and high levels of fibrinogen were significantly more prolonged in placebo-treated patients. CRP and SAA were extremely elevated and peaked at 24h, remaining less marked in the IFN-treated patients but the difference was not statistically significant. Observations regarding the other parameters were unremarkable.

Conclusions
Although there were some clues indicating a depressed inflammatory response with IFN, we could not demonstrate a definitive effect of this agent in this double-blind trial. The drug may suppress the acute inflammation of FMF only if administered at the earliest phase. CRP and SAA may be more sensitive indicators of an attack than ESR or fibrinogen.

Key words
Familial Mediterranean fever, colchicine, interferon alpha, acute phase reactants, C-reactive protein, serum amyloid A protein.

This study was financially supported by Schering-Plough Tibbi Ürünler Tic. AS, Turkey.
Please address correspondence to: Dr. Mehmet Tunca, Dokuz Eylül University School of Medicine, Department of Internal Medicine, Balcova, 35340, Izmir, Turkey.
E-mail: tunca@superonline.com
or mehmet.tunca@deu.edu.tr