Efficacy and safety of interleukin-1 blockers in kidney transplant recipients with familial Mediterranean fever: a propensity score-matched cohort study


 
 
 Data on use of IL-1 blockers in kidney transplant recipients (KTRs) with familial Mediterranean fever (FMF) are very limited. We aimed to evaluate the efficacy and safety of anakinra and canakinumab in the transplantation setting.
 
 
 
 In this retrospective cohort study, we included KTRs suffered from AA amyloidosis caused by FMF and treated with anakinra or canakinumab (study group, n = 36). Using propensity score matching, we selected 36 patients without FMF or amyloidosis from our database of 696 KTRs as the control group. Primary outcomes were patient and graft survival. Biopsy-confirmed graft rejection, changes in eGFR, hsCRP, erythrocyte sedimentation rate (ESR), proteinuria, and number of monthly attacks were secondary outcomes.
 
 
 
 All KTRs with FMF began IL-1 blocker therapy with anakinra and nine (25%) were switched to canakinumab. Overall death was more frequent in study group (19.4% vs 0%) (p = 0.005); however, overall graft loss was comparable between study (27.8%) and control groups (36.1%) (p = 0.448). Five- and 10-year graft survival rates were significantly higher in study group (94.4% and 83.3%, respectively) than control group (77.8% and 63.9%, respectively) (p = 0.014 and p<0.001, respectively). Rejections were numerically lower in study group (8.3% vs 25%), but it did not reach to statistical significance (p = 0.058). When compared to pre-treatment period, with IL-1 blockers, number of attacks per month (p<0.001), eGFR (p = 0.004), hsCRP (p<0.001) and ESR (p = 0.026) levels were lower throughout the follow-up; whereas proteinuria levels were not.
 
 
 
 Anakinra and canakinumab are effective in KTRs suffering from FMF; however, mortality rate may be of concern.
