Kevzara is being suggested

[Kritterkid]

Hi,

A little history is that I was treated for PMR wi starting dose of 15mg Pred from Jan 2018 tapering to zero Oct 2020.

Then in July 2024 I had symptoms & elevated CRP and given a starting dose of 10mgs. Dropping to 8.75 didn't keep up with the pain so I am back up to 10.

I wrote to my Rheumy that I had to increase the Pred back to 10 and his response was that we will discuss using Kevzara shots at my appointment on Aug. 27.

To be prepared for that appointment, I am gathering data on Kevzara. There are some here who are on Kevzara and having some success, as I understand it.

I am going to ask him why 10mgs was my starting dose this time, plus is it normal to go to Kevzara shots so soon? Maybe I am missing something.

Thank you !

[PMRpro Ambassador]

You don't say on your profile where in the world you are but I am assuming the USA? Kevzara is a recent option for PMR, approved fairly recently by the FDA, Before you start it, be sure your insurance will pay for it, they may be a bit stingy and your co-pay may be hefty!

I suppose there are doctors in the USA who will consider that a heavy duty biologic is preferable to a low to moderate dose of pred - I'm not sure I would to be honest and I speak as someone on a similar biologic used to get me down from a pred dose of 19mg/day. Having failed to get below 7mg pred without a return of bicep tendinitis and only being expected to get to 5mg anyway because of potential adrenal insufficiency, I am now working on extending the gap between injections to minimise the risks of the Actemra.

Biologics are very specific, they work on a single factor. GCA, and therefore presumably also PMR, is known to have at least 3 different underlying mechanisms which can cause the inflammation. Like Actemra, Kevzara only works on one of them and if the others are involved you will continue to require some pred to manage them. Biologics also have a considerable effect on the immune system, leaving you at an increased risk of infection and it is usual to stop them temporarily if you do develop an infection.

In other rheumatological conditions it is usual to start with the hand guns first - and keep the cannons for later. So why is there now this different approach with Kevzara? It has only been approved by the FDA since May 2017 for RA so the longterm experience with it is still relatively limited.

I do look forward to hearing what your rheumy has to say when you question them.

[Kritterkid in reply to PMRpro]

Thank you PMRPro for the data and the great line "start with the hand guns first and keep the cannons for later." That sums up my thoughts!! I will let you know how my appointment goes.

Thanks again!

[QiRelief505 in reply to PMRpro]

PMRpro,

Thank you for this very informative post. I’m in the US and rheumatologist recommended Kevzara last week now that I’ve been off Pred for 2.5 months (tapering schedule from 15 x 1mg over 15 months.) I’m managing with 600 mg of ibuprofen and after cursory reading about Kevzara honestly felt she IS bringing out the canon! : )

I’m in New Mexico and there are are only two rheumatologists in my area, but think I need a second opinion. It seems UK tapering can go on for years. I understand trying to get off Pred as soon as possible, but I did very well on 4 mg and had hoped to go back to that for an extended period of time.

Thanks again for your helpful post, and best to you.