Vaccines & Increased Prednisone

[Kuipersr2]

Diagnosed with PMR in August 2022. Started at 20 mg Prednisone, down to 5 mg of prednisone. Also prescribed hydroxychloroquine. My rheumatologist instructed me to get RSV and Pneumonia vaccines which I did today. He is prescribing me biologic, Kevzara because I am experiencing quite a bit of discomfort while tapering off prednisone. In anticipation of these 2 vaccines, I increased my prednisone to 10 mg today. My question is should I go back to 5mg tomorrow or stay on 10 mg for a couple days to guard against a PMR flare from the vaccines? Thank you.

[PMRpro Ambassador]

I would go back because the higher the pred, the less efficient the development of immunity as a result of the vaccine which rather defeats the object! If you have problems post vaccine, paracetamol/acetaminophen is usually plenty to soothe them.

After only a year of PMR and having achieved 5mg, I'm not sure I would take Kevzara. Kevzara is also only a "steroid sparer", it won't cure the PMR. PMR does NOT only last 2 years and your discomfort is almost certainly because you have tapered too far too soon. But I'm sure the doctor is excited to use a new drug. Is your insurance agreeing to cover it?

[Kuipersr2 in reply to PMRpro]

Thank you PMRpro for your insight. Insurance as expected rejected it so now doctors office is fighting it and sending all medical documentation.

[PMRpro Ambassador in reply to Kuipersr2]

I don't think it is the end of the world - a little bit more pred and a more sensible taper and you will be fine without it. They are in such a hurry - and there is no guarantee the Kevzara will get you to zero - like Actemra, it only works for one underlying cause of the inflammation, the IL-6, and there are others, If they are involved, then you may need a low dose of pred ongoing. And they don't yet have longterm studies regarding adverse effects - they know a lot more about pred and it isn't half as bad as many doctors think! Do you have any adverse effects due to pred?

[Kuipersr2 in reply to PMRpro]

I agree that taking a biologic is worrisome specifically the potential for serious infection. I tolerate Prednisone well as it relieves my pain and stiffness when on a high enough dose.

[Kuipersr2 in reply to PMRpro]

Every doctor I come in contact with wants prednisone eliminated as quickly as possible.

[PMRpro Ambassador in reply to Kuipersr2]

Most of them do - and they cause a LOT of problems as a result. In the US you can have the biologics if the insurance plays ball - but will they play ball long enough? In the UK they don't have that option but most still are desperate to get people off pred come what may. It is a fundamental lack of understanding of the disease.

[Kuipersr2 in reply to PMRpro]

Thanks for sharing your experiences and knowledge with me. You are an asset to this forum.

[PMRpro Ambassador in reply to Kuipersr2]

Thank you