Anyone having injections of Depo-Medrone instead of taking prednisolone orally to manage symptoms of PMR?

[Bennijax]

Anyone having injections of depo-Medrone instead of taking prednisolone by mouth for PMR symptoms? If so, do you prefer this method? How does it work?

[PMRpro Ambassador]

In all my years on the forums I have come across only 3 people who have been managed with injections - and one on here wasn't initially being managed properly. Prof Dasgupta did a trial using 80mg monthly I think - this other rheumy wanted to keep it to 3x per year which isn't enough.

There is a series of threads from Admiral06 who was on injections:

healthunlocked.com/user/Adm...

You need to go back to the oldest ones, 4 years ago, for the injections story.

[Bennijax in reply to PMRpro]

Is there a way for this conversation oaths post to be saved, and printed?

[PMRpro Ambassador in reply to Bennijax]

Screen print? Copy and paste into Word?

[TheMoaningViolet]

Hi Bennijax,

I had one injection early on . It was wonderful for a week, than a sharp decline in effectiveness over the second week, followed by slower decline in effectiveness with significant PMR symptoms. 5 weeks later, I could barely walk again. So it was not the right treatment for me, but it may be fine for other people.

[PMRpro Ambassador in reply to TheMoaningViolet]

It is supposed to be repeated every 4-5 weeks in order to manage PMR/GCA, Used properly it is very good - and calms doctors down because the total dose of pred is lower as a result of the 100% bioavailabilty and they don't think of the fact that a patient who is on 10mg with a 50% bioavilability is also only getting 50% to contribute to adverse effects (if you see what I mean )

[TheMoaningViolet in reply to PMRpro]

Yes, but I was feeling well only for a week. By the time 5 weeks have passed I could barely walk. As opposed to feeling fine most of the time on Prednisolone. I am in favour of trying it and seeing how one responds to it (which is exactly what I did).

It occurs to me that the fine tuning most people do, based on how they feel, is also not really possible with the injections.

[PMRpro Ambassador in reply to TheMoaningViolet]

I am assuming it was a depot injection you had? They are different - it's like the slow release tablets you can get that release their dose over the whole 24 hours, not just a one-off dose when you take them.

The main reason for your experience is that the quantity released into system at the start is relatively high and then steadily falls off over the following weeks so at some point you are likely to get below the dose you need to manage the inflammation. Most doctors would start higher than that and then reduce the starting dose later. But you are likely to have a poorer effect just before the next dose is due and a good doctor would balance the starting dose against the frequency of injection.

[TheMoaningViolet in reply to PMRpro]

I will check the dose and let you know. I was very interested in this, but the rheumatologist who administered the injection did not think it was a correct treatment for me. I would appreciate you comment once I check the dose.

[Bennijax in reply to PMRpro]

I’ve experienced a remarkably positive reaction to the lower dose by injection, but no doctor or web search has been able to explain the science behind this approach and how it might be good for one and not for another.

The good effects from the 80 ml dose Jan 8 lasted for one month then started to tail off. My blood test results from third week in March were very good, all but two were slightly over or under the normal range , best bloods for a year. Go figure. Then this week, nearly four months since the 80ml injection, the flare began. I’m in a poor situation at the moment with the COVID-19 making medical communications much more difficult. I could begin oral dose offered by my GP, starting with 10mg a day but in the past I had terrifying reactions to Preds by mouth. I had to take high doses twice when I lost hearing in one ear, luckily they worked and I regained some hearing. My rheumatologist has me down as reactive to steroids by mouth, so the idea is to try to manage PMR symptoms by the least qty of steroids, and she agreed to continue to try the injections as they seem to help me.

[PMRpro Ambassador in reply to Bennijax]

Have you seen the small scale trial done by Dasgupta in 1998? You can read the entire report:

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

Not sure what you mean about the science - it is simply a different form of corticosteroid that gives a constant supply systemically but one that does fall off over time so it requires repeat injections which can be made smaller or the time between lengthened to taper the dose over time. It was never intended to be a one-off injection - that will never work for PMR, it is a long term condition, so repeated depot injections are appropriate. You have been extremely lucky for the effect to last so long before the inflammation built up enough to cause symptoms.

[Bennijax in reply to PMRpro]

PMR pro, thank you, your comments are helping me understand better. May I check if I am?

You mention bioavailability. I think I took in from what you write that the injection with D-M offers 100% availability and the oral dose gives 50% availability. Does this differ greatly from person to person? Or is this a known factor?

No doctor informed me that the injection is done every 4-5 weeks. Certainly there is a shortage of rheumatologists in London and they are overwhelmed with growing patient lists covering all varieties of rheumatic conditions, most much worse than PMR. With every minute spent with a patient a dwindling resource, they prioritize what can be offered.

I have no other health condition, I hope I can convince my GP to make the surgery nurse available to me to administer the D-M, maybe every five or six weeks, that might work. I dearly appreciate the time you’ve given to my question today.

[Hidden in reply to Bennijax]

I don't know if this will help.

pubmed.ncbi.nlm.nih.gov/112...

[Bennijax in reply to Hidden]

thank you

[PMRpro Ambassador in reply to Bennijax]

One of the ladies who was on depot-medrone, for GCA as it happens as she couldn't take oral pred because of her gastric history, had her injections administered by her husband, they taught him what to do. For some reason she had to have them in her buttock, she could have done them herself into the thigh. It gave them a lot more freedom as she needed them frequently initially at the high doses needed for GCA.

All the active substance in injections of any sort is available to the body, if they are i.v. it is immediate, i.m. is slower, in the case of these injections it is released slowly over weeks. Oral medications must be absorbed by the body from the gut and the proportion will vary from person to person due to the drug, how it is taken and GI conditions. Although most doctors lack of awareness of pharmaceutical biodynamics means they assume it is the same for everyone but while the usual assumption for oral uptake of corticosteroids is 70%, in fact it probably varies between 50 and 90%. GI disorders affect it - coeliac disease for example reduces the amount absorbed, Any substance is only of any use if enough is absorbed in a reasonable time frame before it passes further down the gut on its merry way to the sea

I suspect a lot of doctors aren't aware of the work, just know that it is possible. It is work done 20 years ago and isn't used commonly so they don't become familiar with it and if they can't be aware of newer suggestions for better tapering they won't go looking for other older work. Some will use it to diagnose PMR - thinking it is an easy way of administering steroids since they don't seem to know that you can give a short course of pred without having to taper. But won't understand that the limit of 3 per year for intraarticular injections (into joints) does not apply to intramuscular use - nowhere near the tendons that are at risk. Others use it for a flare - doesn't appear to occur to them it is only another way of increasing the dose! One lady was told she could only have 3 per year, which of course is nothing like enough for most people. and in between must take oral pred.

Anything else I need to cover?

[Bennijax in reply to PMRpro]

BRILLIANT. Best reply I've had. XXXXXXX

[Bennijax in reply to Bennijax]

"All the active substance in injections of any sort is available to the body, if they are i.v. it is immediate,

i.m. is slower, in the case of these injections it is released slowly over weeks.":

would you explain, what is i.v. and i.m.?

do you know, are the usual D-M injections i.v.?

[PMRpro Ambassador in reply to Bennijax]

i.v. is intravenous, i.m. is intramuscular.

Depotmedrone is intramusclular - injected into a large muscle.

[TheMoaningViolet in reply to PMRpro]

Hi PMRpro, I checked the letter and I had "an intramuscular depomedrone 120mg injection". The morning after I cried I was so happy, no pain at all, but it was short-lived. I am sure the rheumatologist would have continued with this approach had I been the right candidate, after all, he suggested it.

[PMRpro Ambassador in reply to TheMoaningViolet]

Where did he give it?

[TheMoaningViolet in reply to PMRpro]

I think my buttock. ( I assume this was the gist of your question?)

[PMRpro Ambassador in reply to TheMoaningViolet]

Wonder why it didn't last ...

[TheMoaningViolet in reply to PMRpro]

It was very disappointing as he told me that overall one would need to take less steroids (as you were suggesting). It's not that it didn't work at all, it's just that the outcome was not very satisfactory.

[DianeA1]

After being diagnosed with PMR, I was given that shot for treatment. The next day I was still had immense hip, knee and neck pain, was nauseous, dizzy and then completely bed-ridden for about 8 days. They prescribed Phenegren (sp) which helped the nauseousness, and 15 mgs of Prednisone which took away the pain the same day I started it.

Stay safe

[JCarter1155]

I take oral Prednisone ...since no one is exactly alike, I have control first hand over my body..I have increased my own dose three times this year when I felt symptoms worsening..I’m using the DSNS and next week I’ll have a 2mg dose for one day..

[Bennijax in reply to JCarter1155]

Dear J Carter, I see the advantage of taking oral preds. But they come with many other issues - having to take drugs to protect calcium loss, having to take omeprazole because the preds are hard on the digestive system. I do well on the injections (so far, I suspect) because they bypass the stomach. I am considered to be very reactive to steroids by mouth, that is acknowledged. The rheumatologist I was registered under recognised that because of other medical and health issues I've had, particularly in relation to the gut, she would be willing to work with me to see how far we could go with the injections, but then her department closed because of the virus.

I don't know what do now.

[Hidden in reply to Bennijax]

Hi the coated pred are absorbed beyond the stomach. If you take steps to protect your bones...get dexa scan take adcal and vitk2, eat a low carb diet then pred is not the end of the world. I am 4 years in and bones ok, weight lost, no stomach issues caused by pred. I would rather have the control over what I take and when anyday. Good luck in your endeavours.

medpagetoday.org/rheumatolo...

[Bennijax in reply to JCarter1155]

But, thank you for replying - I wish I could find a buddy, very experienced in this, who might be a help me to transfer over to the oral method. I'm frightened.

[JCarter1155]

Well,

I don’t have digestive problems and I take Calcium even before OMR😉

[Bennijax in reply to JCarter1155]

Thank you.