1mg enteric coated Pred? Efficacy?

[Jbobby]

Hi , wondering if anyone can throw light on this. Im currently on 8mg enteric coated Pred having reduced from 70 mg back in Jan '23. Seem to be doing OK, so far. In order to make up my 8mg dose I have 1 x 5mg plus 3 x 1mg - all enteric coated. There is some scepticism amongst a few of the NHS docs and rheumatologists about the efficacy of the 1mg EC Pred and whether it's actually being absorbed. I can only go by how I feel which is pretty Ok , no serious symptoms returning so far and Ive been on 8mg EC for nearly a month now. Im therefore planning to come down to 7.5mg asap - once Ive had blood tests etc - which wd mean having 1 x 5mg plus 1 x 2.5mg EC Pred. However, Im concerned that IF the docs are right that would mean I was Increasing my dose rather than Decreasing it, if you see what I mean. In other words, IF NHS is right I have actually been on more like 5mg Pred for the last month. I feel somewhat sceptical about their scepticism(!) but wondered if anyone had had experience of the 1mg Pred working - or not working - before? I'm not keen on going on ordinary Pred as trying to protect stomach as much as possible and can't manage PPI's. Would be grateful for any feedback.

[PMRpro Ambassador]

Well I'm dismissive of their scepticism too - if you are doing OK it suggest it is doing its job and if they were right and it weren't you'd have dropped more than 1/2mg and our experience is you would have noticed.

You say you can't manage PPIs - increasingly doctors are going back to good old-fashioned H2 antagonists. Different mechanism, different adverse effects and almost equally as effective in fact, The PPI marketing was very persuasive but they are starting to realise they aren't as good as they claimed.

[Jbobby in reply to PMRpro]

Thank you v much PMRpro. Thats interesting about H2 antagonists..... I think Im going to continue with EC Pred, eating yoghurt etc with or before. So fat I don't seem to have stomach problems. Im interested youre dismissive of their scepticism, and reassured. I have suspected, as DL has just said, that its a cost thing.....

[DorsetLady PMRGCAuk volunteer]

There is some scepticism amongst a few of the NHS docs and rheumatologists about the efficacy of the 1mg EC Pred and whether it's actually being absorbed.

Based on what evidence?

Being a sceptic-I’d say their decision was affected by cost … EC 1mg are £30 plus for 100, whereas are less than 70p for 28.

[Jbobby in reply to DorsetLady]

My suspicions too DL. Thank you very much for your reply...Im going to keep going and come down to 7.5mg EC asap, and then 7mg EC which will again include the 1mg EC Pred, and see what happens.

[DorsetLady PMRGCAuk volunteer in reply to Jbobby]

They may belong to the same school of thought as those don’t think 1mg (of any sort) makes a difference. But many on here would disagree..

Good luck

[Jbobby in reply to DorsetLady]

Thank you DL! Will keep you posted.

[Highlandtiger]

I agree with DorsetLady that it’s probably more about the cost. I’m currently on 3mg and on EC so, at my current dose, ALL I’m taking are 1mg EC ones. They’re working for me!

[Jbobby in reply to Highlandtiger]

Thats great to hear, Highlandtiger. And reassuring. Thank you. I'm going to forge ahead!

[piglette]

I have worked with the pharmaceutical industry for over thirty years and I am sometimes quite gobsmacked at the lack of knowledge of some doctors regarding medicines. Mind you I know one consultant who got muddled up between PMR and fibromyalgia.

[Jbobby in reply to piglette]

Thank you Piglette. It is a bit concerning. Whilst having huge respect for those in the medical profession I know I have a tendency to be sceptical about docs’ recommendations and advice at times and I question everything and drive them mad…. But it seems that so often they arnt right and/or don’t have time or inclination to look at individual cases and just think same size fits all. ‘NOT the case’ I cry!

[piglette in reply to Jbobby]

My father was a doctor and he could not diagnose a broken arm. The thing was it was his arm!