Sociodemographic and Clinical Determinants of Colchicine Adherence in Adults with Familial Mediterranean Fever: A Cross-Sectional Study

Colchicine is the cornerstone of familial Mediterranean fever (FMF) treatment, effectively preventing attacks and amyloid A (AA) amyloidosis. Its effectiveness depends on long-term adherence; however, data on adult adherence remain sparse. We aimed to evaluate colchicine adherence in adults with FMF and identify factors associated with low adherence. This cross-sectional study consecutively enrolled adults with FMF fulfilling Livneh/Tel-Hashomer criteria and receiving colchicine for ≥ 3 months. Adherence was assessed using the Turkish 8-item Morisky Medication Adherence Scale (MMAS-8™) alongside sociodemographic and clinical characteristics. Of 104 patients (median age 37.6 years; 32.7% male), adherence was low, moderate, and high in 28.8%, 45.2%, and 26.0%, respectively. MMAS-8™ scores correlated with physician- and patient-rated adherence ( r = 0.53 and 0.50, respectively; p < 0.001 for both). Low-adherence patients were younger (median ages of 31.2, 42.6, and 43.1 years; p < 0.001), and age increased across adherence categories ( p = 0.001). In multivariable analysis, low income (≤ 1 × national minimum wage; odds ratio (OR) 4.78; 95% confidence interval (CI) 1.01–22.56; p = 0.04) was associated with higher odds of low adherence, whereas older age (OR 0.92 per year; 95% CI 0.87–0.96; p < 0.001) was associated with lower odds of low adherence (vs. moderate-high adherence). No statistically significant associations were detected between adherence and the evaluated disease activity measures, family history, or immune-mediated inflammatory diseases, and no robust association was identified between available Mediterranean fever gene ( MEFV ) genotype data and colchicine adherence. Nearly one-third of adult patients with FMF exhibit low adherence to colchicine. Younger age and low household income were associated with low adherence. Routine adherence assessment and targeted support for potentially vulnerable subgroups may help optimize long-term outcomes. Graphical Abstract available for this article.