Previously mentioned study - about weight related dosage of Prednisolone

[Lookingforideas]

I saw a mention on here (I think it was by someone called Navion?) about a study done that was recommending 0.19mg Prednisolone per kg body weight as a starting point. Is there a link to that anywhere please?

Thanks for any info anyone can give me on that study or any other related information?😃

[PMRpro Ambassador]

I suspect you mean this study - which didn't actually recommend that as a starting dose but that was the mean dose found in the responders in the study:

"47/60 (78.3%) patients responded to 12.5 mg of prednisone after a mean interval of 6.6 ± 5.2 days. In univariate analysis, body weight and gender discriminated the two groups. In multivariate analysis, the only factor predicting a good response was low weight (p = 0.004); the higher response rate observed in women was explained by their lower weight. The mean prednisone dose per kg in the responders was 0.19 ± 0.03 mg in comparison with 0.16 ± 0.03 mg for non responders (p = 0.007)."

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

[Lookingforideas in reply to PMRpro]

Hi there. Thanks so much for the quick reply 😃. That is the study I was after, and after posting my question I actually found it myself. Sorry I was being a bit lazy there 😊

So, I’ve skimmed through most of it ... and It’s really interesting and bears out my ‘gut feeling’ that like vets- it would be useful if Drs could take size/weight into account when prescribing various drugs. I think it’s Particularly important in regard to the likes of Prednisone with its side effects increasing with the cumulative dosage...

Anyway, as I’m about 58kg, according to that study, I should (hopefully)be able to ‘get by’ on about 11 or 11 & 1/2mg of Prednisolone as a base level, rather than the full 15mg which my GP prescribed-

I’ve only been on it for 12 days so far and to be honest had (based on my extensive reading around it and hundreds of posts in here) already been alternating between 12.5 by cutting a tablet in half and 15 since the 3rd day, then been doing two days on 12.5 and one on 15 etc since then and my symptoms seem fine so far - although I’m monitoring myself carefully... so here’s a sort of a question...

as I’m still within the very early days when I believe there is still a little bit more manoeuvring ability before my body is dependent on the dosage staying within the 10% reduction levels over a longer period - I’m thinking I’ll dip to 11.25 now before I hit the ‘2 weeks on steroids’ mark and become more dependent... and see how I go ...

I know you don’t give medical advice in here but as long as I am vigilant to any creeping back of symptoms and ready to revert to the GP/NICE prescribed dose If necessary- I’d be interested in knowing your opinion (and anyone else’s?) on if I’m being ‘reckless’ or just sensibly experimenting on myself within already researched parameters?

Sorry for the stream of consciousness... just thinking out loud 🤪

Whatever your opinion on all of that, thanks for everything you do on here - it’s an incredible site and I’m finding so much great information on here, as well as benefiting from the engagement with others in the same boat. THANKS😃👍

[PMRpro Ambassador in reply to Lookingforideas]

I don't think they are already researched parameters - since no studies have been done and there are a lot of variables besides weight. The activity of the underlying disease is also significant and how much accumulated inflammation is present as well as which structures are involved. It was some months before the bursitis part of my PMR was fully cleared although I had an amazing change in stiffness and muscle pain in response to 15mg in under 6 hours. There is another unknown factor in the bioavailability - some people absorb 90% of their oral dose and others only about 50%.

Previously 30mg was a quite usual starting dose for PMR - and anecdotally a few people with relapses have commented they did better in the long run on higher starting doses. In the case of GCA, a study found that patients started on very high dose pulse therapy of 1000mg/day for 3 days before a more normal taper from 80mg were able to taper to low doses more easily and overall had a lower cumulative dose.

All I want to say is that starting low may not be the benefit you think it is. The 2015 recommendations actually warn against starting at a low dose - the risk you run is that it isn't enough and you creep up the dose leaving the patient taking pred with absolutely no benefit at all which is accumulating dose. You have been lucky and I hope it lasts - but it isn't something I would encourage too many people to try.

There isn't really a point of dependency - don't misunderstand the meaning of that. You need the dose you need to manage the inflammation, it is that that dictates, not your adrenal function. And being at a physiological dose of 7mg or so over a long period will still result in suppression of production of cortisol by the adrenal glands. It may be easier to regain that function but there is no guarantee of that.

[Lookingforideas in reply to PMRpro]

Thanks so much. You are clearly the voice of reason and obviously know a huge amount more about all of the implications and ramifications of this than I do, so I really do appreciate your insight. Yes, on reflection maybe I’m being a little cavalier in my attempt to minimise the steroid dosage without enough in depth knowledge about the difference in effects in the individual, or the longer term effect from the starting level dose.

I had read a little about the bioavailability but only skimmed it and had (quite flippantly) assumed that as my (horrific) symptoms pretty much disappeared within about 4 or 5 hours of taking my first dose, and have been 90% better consistently since, that I was a ‘good responder’ or that the dosage was plenty and maybe ‘overkill’? But yes, maybe I’m just lucky so far, and that’s leading to a bit of complacency and a possible nasty wake up call if I’m not careful 😳! You are making really valid points and based on that, I need to reassess my attitude to this aspect.... and read more studies properly!

I’m so grateful for your help and if you have any other thoughts or insights that you think might help to rein in my overly enthusiastic inclinations please do tell me 🙏even if it’s not something you think I’d like to hear 😊

Thanks again for your help

[PMRpro Ambassador in reply to Lookingforideas]

As I have said, I had a miracle in under 6 hours with 15mg - but I still really struggle to get below 10mg in the long term!

[Lookingforideas in reply to PMRpro]

That ‘miracle’ start is exactly like me, so I need to stop assuming it’s always going to be plain sailing for sure!!! How long have you been struggling with it? - oh actually, i need to look for myself don’t I!?! you’ve probably told everyone one here already so I need to catch up 😊. If I want to follow your posts and read about yours (or anyone else’s ) specific journey, I believe I can ‘follow’ people on here- how do I access that facility?

I hope you get some success with your tapering efforts soon after all the research you’ve obviously done ... just not dealing with a cooperative body right now? This is a steep learning curve for sure 🙄. Thanks again 👍

[PMRpro Ambassador in reply to Lookingforideas]

I have had symptoms of PMR for the last 15+ years and been on pred for 10 1/2 years. Initially I got to 5mg quite easily but was told to stop after a total of 6 weeks - of course it all flare up again and it has never been so easy again. I did get to below 5mg about 2 or 3 years ago but had to go up a bit for another reason and then had another big flare meaning I currently need 15mg again. But most of the time I have a good life and do most of what I want to - thanks to pred.

[Blearyeyed in reply to PMRpro]

Thanks Pro , that was a really helpful and interesting reply , as ever.