Abiraterone weaning

[Derf4223]

When the time comes to stop ADT and abiraterone, for good reasons. Does anyone here have info on abiraterone weaning planning? Including prednisone weaning? TIA

[Mascouche]

Abiraterone does not require weaning off from.Prednisone does and the slower the better.

The way that impacted me less was to take the regular dose one day and then half that dose threw next day, then the regular dose then half the dose. The following week I slashed all those doses by half and repeated the process.

For example, I had been on prednisone 10mg for 2.5 years. To wean off I did :

Week 1: on even days I took 10mg and on uneven days I took 5mg

Week 2: on even days I took 5mg and on uneven days I took 2.5mg (by cutting the pill in two halves)

Week 3: on even days I took 2.5mg and on uneven days I took nothing

Week 4; nothing.

Hope this helps!

[Gatodd]

My MO told me that I did not need to wean off at 5mg, since it was a low dosage. But after 2 days with no prednisone, my blood pressure jumped significantly (180 over 110). The only time I ever had experience high blood pressure was when I started on zytiga and prednisone, which dissipated and returned to normal after about a month.

After seeking counsel from this forum, I started weaning slowly over a month, checking blood pressure regularly. If blood pressure got too high, I slightly increased the amount of prednisone that day or didn’t skip a day at the lower weaning dose.

I weaned over the period of 1 month. Blood pressure has returned to normal. It’s been about 5 months. To me, little is gained by a cold turkey stop. So, a data point of 1 based on my experience.

[Scout4answers in reply to Gatodd]

My MO prescribed 1mg. tablets and I weaned over 4 weeks, knowing others had gotten in trouble quitting cold turkey. Easy to do but who will ever know if it was needed.

[dhccpa in reply to Gatodd]

I don't know why some docs don't get it. I thought weaning was good advice when abandoning any steroid. But yours is not an outlier.

[JohnInTheMiddle]

I have to assume that you are "weaning" from Abiraterone for some reason? Not financial ☹️? But because you have a new therapy plan? Stopping Abiraterone must be because your doctor said there's a liver issue? Or because of resistance? Tell me you're not going on holiday ... 😀

[Derf4223 in reply to JohnInTheMiddle]

It is all as per trials applicable to my case. Nothing sinister. Last night I decided to taper prednisone and abiraterone together over the rest of July, since I have enough of each. 500 mgs/day for 10 days, 250/day for another 10 days, then skip alternate days. Paralleling with prednisone in proportion to what I have been taking with 1000mg/day abiraterone. I want to minimize the chances of adrenal insufficiency.

Resource links

How long to take prednisone after abiraterone discontinuation

ncbi.nlm.nih.gov/pmc/articl...

Adrenal insuffiency (abstract of a pay-walled article)

thelancet.com/journals/lanc...

It is not easy to find much on best ways to taper abi, but a bit easier for prednisone.

Wish me luck!

[JohnInTheMiddle in reply to Derf4223]

The very best of luck Derf!

As for the reason for tapering and stopping, I'm still puzzled. I wouldn't want to suggest anything sinister for sure.

But apparently your tapering has to do with your participation in a trial? Are you able to share more?

[GrantB47 in reply to JohnInTheMiddle]

My own plan per my MO is two years of abiraterone and prednisone coupled with three years of Elgard. I would presume this is Derf's situation. Is that ill-advised?

[JohnInTheMiddle in reply to GrantB47]

I'm not a doctor just I reader of PCa literature. Tall Allen is authoritative based on his mastery of research.

That said I read your bio, and I can't tell if you're metastatic or not. My understanding is that sometimes people will go off Abiraterone etc., if there are liver issues etc etc.

My reading is only concerning metastasis and associated therapy. If one is not metastatic or only marginally so then apparently there are different protocols.

From the literature once a person is metastatic, then there's no going back. And I am resigned to being in this new state of being forever. And that means likely ADT forever. And other meds likely.

Apparently even if one develops resistance then you still don't stop ADT. Testosterone suppression is still a good idea even if you have an evolved cancer that thrives without testosterone.

One thing I have noted is that there is a lack of consistency between doctors in different geographies and institutions and likely even practices. The newest therapy regimes that are now "in the wild" are dramatically better than older regimes. But we see time and again doctor recommendations that are up to date as of 4 years ago. (As in not-up-to-date 😃)

[GrantB47 in reply to JohnInTheMiddle]

Thanks for the response. I believe that I am oligometastatic and have undergone radiation for the two or three lesions in my back as well as for my prostate. Should that make a difference. I get my treatment from the VA and, while I rarely see an actual doctor, they seem to be following the established protocol. I will see them again at the end of August when I get my fifth shot and I will try and get a more definitive response about the two year abiraterone prescription. Best wishes.

[JohnInTheMiddle in reply to GrantB47]

I'm in Canada, but the VA I would expect would be following SOC.

[GrantB47 in reply to JohnInTheMiddle]

No doubt.

[Derf4223 in reply to JohnInTheMiddle]

No trial involvement, just trials like LATITUDE and CHAARTED. And also because I have about 1/2 a bottle of abi and plenty of prednisone. The abi was cheap, scriptco.com about $90 a bottle. I read somewhere that weaning was how a trial concluded abi. See the link below. It has other warnings, worth a read. Of course one could go to the official website for Zytiga, but that is dense and layman-unfriendly.

Resources

quickrxspecialty.pharmacy/s...

[jmarsh]

Abi required no weaning, according to my MO. Pred does. Everyone seems to have a different opinion on this. I tried to go too fast, but per my Docs instructions. My blood pressure went up and I had an headache. We went to a slow taper over the course of a month or longer, and that seems to be working.

[Derf4223 in reply to jmarsh]

@jmarsh, was it abi or prednisone or both that you had to taper? Stopping abi can increase BP, and HBP can cause headaches.

[Bdale]

Interesting, when Abi stopped being effective my MO just told me to stop both Abi and Prednison. No weaning, I also had no side effects that I could tell. My blood pressure was already high when taking 250mg Abi plus 5mg Prednison. I moved to Keytruda after that and BP is back to normal.

[Jbooml]

I believe it is range affected in that the longer you were on it the longer you taper. I took months to taper at 5 mg to keep the joints happy..I’m totally clear of it but I do believe I have been left permanent joint issues albeit at 71 yrs who can really say as I’m still having Eligard shots every 4 months. Surviving on ADT is a double defined condition with some not able or willing to keep up with.

[Derf4223 in reply to Jbooml]

@Jbooml Your profile is devoid of PCa case specifics. Of course its your privilege to not add any. Were/are you on abiraterone (zytiga)? L launched this thread about abiraterone weaning but some responders decided to speak about prednisone.

[Jbooml in reply to Derf4223]

I’m 6 yrs into treatment..using both Eligard Zytiga/preds 5.5 on the former and 4.5 with the latter. Started with bicaludamide. no surgery rads or chemo. Dxed stage 4 multi bone Mets. ADT treatment has been very successful to date. If things go off the rails I will resort to ivermectin and fenben.

[Oceankayaker]

I was on Firmagon and Zytiga with Prednisone 5 mg twice a day for 24 months. My MO did not say to taper the prednisone but as a pharmacist I did feel comfortable with that device. I initially did a 7 day taper, then stopped. My BP dropped, I lost my appetite, and could barely eat 1/2 my usual without feeling like I had to vomit. In otherwords I was having adrenal insufficiency symptoms. I started 5 mg pred daily. I had another MO by then who said I would probably have to take prednisone for ever. Long story short, I ended up tapering over 6 months and at end of June stopped. I did come across an article suggesting having to stay on prednisone permanently. I did not taper abiraterone..

[Derf4223 in reply to Oceankayaker]

Oceankayaker How did you come up with your 6 month pred tapering plan? 5 mg is AFAIK one of the smallest doses without splitting. Did you have any signs of adrenal insufficiency at the end of the 6 months?

Per my MO's instructions, I stopped 1000 mg/day abiraterone and 7.5 mg/day prednisone for about 4 days, then decided to taper both, out of an abundance of caution. My taper plan is intended to take a month and I created it by non-doctor self. Starting with 1/2 the dose of each for about 10 days, then cutting that to 1/4th for another 10 days, etc.

As of last night on phase 1 of tapering, my BP is a bit (2-3 points both S and D) down but feeling no ill effects. I had a slight loss of appetite this past week but whilst on full prednisone and abiraterone I had a big problem with sugary/carb-snacking urges, so I am monitoring that but have plenty of weight I'd like to lose provided it happens at a reasonable rate. I'm hoping my T is coming back from a very low base and at a reasonable rate of increase.

PS your bio has not case/age/treatment arc details. Can you fix that? It helps a lot with the quality of responses here. Thanks

[Mascouche in reply to Derf4223]

He mentions taking Prednisone 5mg TWICE a day, so he is tapering off from 10mg, not 5mg.

When I initially tried cutting the dose in half after having taken 10mg a day for 2.5 years, it felt like someone was beating me up in my sleep and I was aching all over. Then I changed my approach for the one I listed in my reply from a few days ago and it went smoothly.

[Derf4223]

Hint to all who stop (or wean off) prednisone and/or abiraterone -- measure your BP daily. If it drops, that's an adrenal distress signal.

[Oceankayaker]

there was no science behind the taper I chose. I just decided to go slow. I had my MO prescribe 1 mg tabs so I could decrease by 1/2 mg at each change. I gave each dose 2 weeks and decreased by 1/2 mg. Some doses required longer time period so I went back to previous strength.

I stopped the 1 mg after 4 weeks and so far it seems to have worked.

I was told not to expect T to return after 2 years ADT.

[Derf4223 in reply to Oceankayaker]

Oceankayaker

Your age is missing from your HU info.

When my MO last month said it was time I could stop abi/lupron/pred I asked if she was going to be involved with my post-treatment bone health. (I was osteopenic at the start and on Prolia per her Rx ever since). Ans: no, suggest you hook up with an Endocrinologist, so I did.

Our first meeting was very interesting. We have a plan for monitoring bone health and also a plan for not just tapering prednisone but then checking how my adrenal gland is doing after that. I think it is a very good move on my part. My Oncology team seems to take a very blindered approach to post-treatment follow-up. Sure they'll watch my PSA closely, but as for post-treatment side effect management, not so much.

The bald statement you quoted "...told not to expect T to return after 2 years ADT" seems to be one of those not-so-much situations. I asked my MO about TRT and she said basically, we will never do that here. If it turns out that my PSA continues undetectable and my T does not come back in 1-2 years, I will find a different MO or ask my endocrinologist about it.

Good luck

[Oceankayaker in reply to Derf4223]

I am 73. My second MO pretty much just concerned with PSA and not so much with anything else. I get another MO in August and see what he says about the whole thing. I was also told the same thing about TRT.

Good luck to you also.