Prednisolone injection rather than tablets

[Andypan]

Has anyone had prednisolone given as an injection for PMR (that’s supposed to last 4-6 weeks). As I had suffered very bad side effects from taking Pred tablets last time (my GP then took me off it), my Rheumy Consultant has now suggested trying an injection instead, as apparently they use a lower amount of Pred and therefore the side effects aren’t as bad. Has anyone heard of this or had experience of it? Any comments gratefully received. Thanks

[Christophene]

Yes, Andypan,

I get depomethylpredlisone by IM injection every 3 weeks at 120 mg. Dr. Das Gupta wrote an article with colleagues in 2011 after they conducted a study of 98 people showing a relief from side effects and remission in 12 weeks.

It seems a little too good to be true. My GP who is close by gives it to me . There are situations where I supplement it by 3 (1 mg) mg oral pills ; (stressful situations) 120 mg for 3 weeks isn't always quite enough ; but I did fall and hurt my shoulder; it's only been 2 injections so far, so too early to evaluate. He mentions a number of things: less weight gain, less fractures, less fatigue and thinks it has implications for treating many rheumatic conditions.

I don't know how it fares for people like me who have been on orals for 3 years. I like not having to play the yo-yo game.120 mg. for 3 weeks works out to about 5mg. a day. I was feeling well at 8 mg so I will see if he can adjust it up a little.

But it is nice to not to have to think about it every day, and it doesn't have to pass through the digestive system, and gets into the blood stream more quickly.

If you try it, let is know how it works for you. Good luck...

[Christophene]

I will try to find the citation for the article when I have a little time, but it was in the British Journal of Rheumatology. My doctor kept the article so I can have a staff person make a copy, and give you the precise citation.

[PMRpro Ambassador]

Deep intramuscular injections of depomedrone are suggested in the 2015 Recommendations for the management of PMR:

rheumatology.org/Portals/0/...

Recommenation 5.

There have been a few people on the forums over recent years who have used them to manage both PMR and even GCA quite successfully. They don't "cure" any more than oral pred does but there seems to be less problem with some adverse effects, they claim less weight gain but weight gain can be managed well even with oral pred.

You start with the depot releasing a relatively high dose which then falls over the following weeks until it gets too low to manage the symptoms and then you require the next injection. That is similar to constant tapers - which is presumably partly how the side effects appear to be reduced. the rest will be bioavailability effects. One lady's husband was taught how to administer the injection - obviously injections every few few weeks can be rather limiting otherwise, weekly ones even more so.

In terms of the article Christophene mentions by Baskar Dasgupta et al, I personally think it is potential they write about! It was completed and at publication stage over 20 years ago - but still isn't a widely used approach.

ncbi.nlm.nih.gov/pubmed/956...

is the link to that abstract. The study was over 96 weeks - as we all now know, that is a time where fewer than 1 in 3 patients would be off oral pred and the numbers are very low. The fact that the dose required is half reflects the fact that the bioavailability of injections is 100%, that of oral pred may be as low as 50% (that is the amount of the dose absorbed by the body). So yes, it should lead to fewer side effects - I suspect that in large population it may vary just as with oral pred.

This member in the USA

healthunlocked.com/user/adm...

wrote about his experiences with injections over quite a time while getting down to about 2mg a couple of months ago.

[Hidden]

Hi there , I was diagnosed with PMR on the 14th of August by symptoms only but my blood tests two weeks previous came back negative for inflammation . The rheumatologist gave me a choice of a year of oral prednisone or an injection of 120mg followed by 7 months of tablets . I took the injection and got results immediately .Unfortunately , my symptoms have returned 2 weeks before I’m due to begin my course of tablets . I’m rather confused and thinking I may have fibromyalgia instead .

Phil

[PMRpro Ambassador in reply to Hidden]

No - you have a very unrealistic (or ignorant) rheumatologist. PMR does NOT last just one year and he cannot know how long you will need pred to manage the symptoms.

medpagetoday.org/rheumatolo...

Only about 1 in 3 patients is off pred in TWO years, 40% still require pred at 10 years, albeit at a low dose, and the median duration of pred management is 5.9 years (that's the time for half of patients to stop pred).

You would have got results with oral pred too - if it is PMR, so it sounds as if it IS PMR, fibro is not inflammatory and doesn't respond at all to pred. But the injections aren't a permanent answer, they have to be repeated every so often, depending on how much pred YOU need to manage the inflammation. The more active the disease, the more inflammation and the sooner you will need the next injection or the higher the oral dose will have to be.

If your rheumy doesn't agree a more reasonable approach - you need a new rheumy.