From the Research
The recommended duration for a trial off colchicine in a PFAPA patient is typically 3-6 months of symptom-free periods before attempting discontinuation, as supported by the most recent and highest quality study 1. When considering discontinuation of colchicine, it is crucial to weigh the benefits of potential symptom remission against the risk of flare recurrence. The decision to attempt a trial off colchicine should be made when the patient has achieved good disease control with minimal or no symptoms for several months. Key considerations for discontinuation include:
- Gradual tapering of the dose over several weeks to minimize the risk of rebound flares
- Close monitoring for at least 3-6 months after discontinuation for any recurrence of symptoms
- Restarting colchicine at the previously effective dose if symptoms return The rationale for this approach is based on the understanding that some PFAPA patients may outgrow their symptoms over time, particularly as they approach adolescence, making medication potentially unnecessary after a certain period 2. However, the optimal duration for a trial off colchicine can vary depending on individual patient factors and response to treatment, as noted in studies evaluating colchicine effectiveness in PFAPA patients 3, 4. Ultimately, the decision to discontinue colchicine should be tailored to the individual patient's needs and disease course, prioritizing morbidity, mortality, and quality of life as the primary outcomes.