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Depending on disease severity or the presence of specific mutations, lifelong treatment with colchicine may be needed. Colchicine prevents inflammatory attacks and the deposition of amyloid. Those who are only mildly affected (with infrequent inflammatory attacks) may either be treated with colchicine or be monitored every six months for the presence of protein in the urine (proteinuria). Others may only be treated with colchicine if they develop severe inflammatory episodes and/or proteinuria as a result of amyloidosis. Those who are unresponsive to oral colchicine may respond to intravenous colchicine, or one of several other medications. Colchicine is not effective as treatment for an acute FMF attack.
The effectivess colchicine depends a person's genotype. For example, people who inherit one (heterozygous) or two (homozygous) copies of the p.Met694Val allele should be treated with colchicine as soon as the diagnosis is confirmed as this drug prevents both the inflammatory attacks and the deposition of amyloid. These individuals need to be on colchicine for life.
People who do not have the p.Met694Val allele and who are only mildly affected (those with infrequent inflammatory attacks) should either be treated with colchicine or monitored every six months for the presence of proteinuria.
Continuous treatment with colchicine appears to be less indicated for individuals who have one or two copies of the p.Glu148Gln allele. Colchicine should only be given to these individuals if they develop severe inflammatory episodes and/or proteinuria as a result of amyloidosis.