Any advice on tapering prednisolone with Methotrexate and RoActemra?

[tweety_pie]

hello...would be grateful for words of wisdom and experience. Feeling confused on how to manage steroid reduction. Started Methotrexate 5 weeks ago and 3rd RoActemra injection tomorrow. Was told to reduce steroids from a high of 55mg at 5mg/week back in May. Am now on 20mg, reducing to 15mg on this programme at the weekend. All seems to be going fairly smoothly but am aware this reduction is now well over the 10% recommended on taper plans. Does the drug mix make slow taper less needful? Have a deal of trust in my rheumatologist but more faith in the forum. Thanks for your time.

[nallufl24]

I don’t know much about Methotrexate but when I started Actemra I reduced prednisone pretty quickly. I went from 35mg to 0 in 7 months. My rheumatologist wanted me to reduce even quicker but at the last few mgs I went much slower. I had no problem except a lot of withdrawal pains.

[tweety_pie in reply to nallufl24]

thanks for this…it’s the withdrawal pains that concern me…I’m sorry to hear you went through them. Imagine again it’s below a certain level where more time is needed. It’s the 5mg/week at this stage that’s bothering me but no withdrawal pains yet

[PMRpro Ambassador]

The 10% is for people NOT on Actemra, which changes all the rules. You can go fast down to 10mg, after 10mg it depends on how long you have been on pred and how sluggish the adrenal function is to return. Also, half of patients on Actemra don't get off pred altogether and 8-10mg is a common dose at which to get stuck. There are at least 3 different mechanisms that produce the inflammation in GCA and Actemra only works on one of them, the production of IL-6, You still need pred for the others if they are involved in YOUR GCA.

[tweety_pie in reply to PMRpro]

That helps with clarity - thank you. Does one discover which proteins are involved in your own GCA by any means other than response to reducing steroids? Not revealed by blood tests? Sorry, probably being dense here…

[PMRpro Ambassador in reply to tweety_pie]

They can be but some are more research orientated and all required specialist labs so not routinely used.

[tweety_pie in reply to PMRpro]

Thanks so much for being so thoroughly well informed and taking time to reply. Have a good evening

[Rugger]

I was on 10mg pred when I started Tocilizumab. My Rheumatologist advised a slow taper at 0.5mg/26days (DSNS). I took the time, as I was fortunate to have 2 years of TCZ instead of one, during the height of the pandemic.

I reached zero pred as the TCZ ration ran out. I then started MTX alone, but the inflammation built up after 6 months, so had to go back on pred and the MTX was stopped. I'm tapering again - now on 4.5 - 4mg at 0.5mg / 26 days.

We're all different! All the best.

[tweety_pie]

Thanks for sharing your experience…certainly seems a slow taper from 10 is best approach and glad it worked for you - sadly only in the short term. All the very best for current path.

[TinaAird48]

sorry I don’t know the reaction of other drugs as I only take prednisolone with my other meds which are not the same as yours , best to ask your G P , I hope you get it sorted and I couldn’t be of more help x