Colchicine prophylaxis efficacy in PFAPA syndrome: A comparative cohort study

BACKGROUND: PFAPA (periodic fever, aphthous stomatitis, pharyngitis, adenitis) syndrome is the most common periodic fever disorder in children, causing recurrent debilitating episodes that impose a substantial burden on children and their families. Current therapeutic approaches primarily rely on corticosteroid administration, which provides rapid symptom resolution but fails to address the underlying inflammatory cascade, prevent future attacks, and carries the risk of side effects. OBJECTIVES: To determine the therapeutic efficacy of colchicine prophylaxis in reducing attack frequency and extending disease-free intervals in PFAPA patients, compared to standard of care management alone. METHODS: This retrospective cohort study included 55 pediatric PFAPA patients, 15 receiving colchicine prophylaxis, and 40 controls managed with standard care alone. The primary outcome was the change in inter-attack interval duration from baseline study completion. Secondary analyses examined treatment response by FMF genetic status and survival analysis for time to next attack. RESULTS: Both groups showed comparable baseline characteristics, except higher FMF mutation prevalence in the colchicine group (73.3% vs. 27.5%, P = 0.002). Patients receiving colchicine experienced a dramatic improvement in inter-attack intervals (median change: 60 days, IQR: 51) compared with controls (median change: 0 days, IQR: 0; P < 0.001). Colchicine's therapeutic benefit was consistent regardless of FMF genetic status. CONCLUSIONS: Colchicine prophylaxis significantly reduces PFAPA attack frequency, with therapeutic benefits that are independent of FMF genetic status. These findings support colchicine as an effective first-line prophylactic treatment for PFAPA patients with frequent episodes or families concerned about frequent steroid use, representing a paradigm shift from reactive to preventive management.