Tapering below 10mg steroid on MTX and TCZ

[tweety_pie]

Bet there's an answer to my query on the forum already but have failed to find so far. Would be grateful for advice. I started MTX (15mgs weekly) 10+ weeks ago and TCZ (weekly injection) 9 weeks ago. Reduced steroids from 55mg by 5 mg weekly until 15mg then 2.5mg for 2 weeks until now at 10mg. Generally felt fine though am (even) more tired in last couple of weeks. Could be other stress factors there.

Have meeting with rheumy in a couple of days. On the given NHS plan, I should go down to 9mg this weekend and reduce by 1 mg each month thereafter. Without TCZ/MTX, I'd likely follow a taper plan in FAQ's here. I'm wondering if they now have a role in managing inflammation that could mean reducing 1mg a month is viable?

[PMRpro Ambassador]

1mg a month is fairly standard below 10mg. The limiting factor now is adrenal function but since you have only been on pred for 5 months it shouldn't be too much of a problem. Whether your adrenals will keep up with 1mg a month below 5mg remians to be seen but it could well be fine.

[tweety_pie in reply to PMRpro]

Thank you… that’s reassuring

[PMRpro Ambassador in reply to tweety_pie]

However - forgot to mention: there are at least 3 underlying mechanisms for the inflammation in GCA. TCZ only works on one of them. If your GCA involves either or both of the others, you may need pred to manage them, If you flare and the rheumie tries to tell you it can't be - yes it could ...

[tweety_pie in reply to PMRpro]

Forewarned, as they say. Most helpful. Thanks

[PMRpro Ambassador in reply to tweety_pie]

It applies to about half of patients ...

[Sharitone]

Should be fine.

I reduced by 1mg a month from 15mg once I had TCZ. At 11mg I was told to speed it up to 1mg per fortnight, and I did get away with it down to 4mg, when I had to stop reducing for a while.

[tweety_pie in reply to Sharitone]

Good to hear. Thanks. I’m guessing you had to stop because adrenals were giving you problems?

[Sharitone in reply to tweety_pie]

Yes, that's right - morning sickness (!) and light-head in the mornings. But it only lasted a couple of weeks.