Lowering meds in order to have injection

[Glassmover]

Dear PMR friends, I was diagnosed with PMR in July of this year and prescribed 15 mg of Prednisolone by my GP who gave me a reduction chart and I am now down to 8 mg. I saw a different GP because I could not sleep who prescribed Zopiclone and said she would refer me to Rheumatologist. However the Rheumatologist via email to my GP said that I should immediately go down to 5 mg of Pred and then reduce quickly down to 1 mg in order to be given the injection instead of pills. I looked on web about this and assume the injection would be ZEVARA (Sarilomab) which apparently lowers the immune system.

Having read this informative and kind chat line I am worried about lowering the Pred so quickly as I understand that lowering slowly is an important part of the process.

To be honest I think I could be able to handle the lack of sleep if lowering the dose slowly from now on as apposed to a quick reduction in order to be on the injection. especially as the injection has worse side effects than Pred.

Kind and helpful information please.

[DorsetLady PMRGCAuk volunteer]

First comment would be 15mg to 8mg within 4 months is very quick.. other than the sleeping issue do you have any other issues?

Wonder why has Kevzara been considered, it’s usually used if you are having problems tapering or having issues with the Pred… and sleep [although tiresome] is an expected side effect and manageable.

To be told to reduce immediately to 5mg and then to 1mg quickly is putting you at risk of a flare of your PMR… and more concerning, adrenals insufficiency which could be very unpleasant.

Kevzara, like any many other similar treatments can take up to 12 weeks to work in PMR… see attached.

kevzara.com/pmr

Like you, I’d be thinking seriously about it. Others who have taken it will be along, but probably have to wait until the US wakes up… used more widely there than UK.

[PMRpro Ambassador]

I think you need to clarify what "the injection" actually is because he MAY be talking about depomedrone, steroid given as a deep i,m, injection every 3 to 4 weeks. If he wants you to start Kevzara, then you don't reduce the pred first - you start the injections and THEN start to taper the pred as the Kevzara takes over the management of the inflammation. What "the injection" is would alter what we say.

I'm on a similar drug to Kevzara called tocilizumab/Actemra, but it was several weeks before I started tapering my pred and that was what the rheumy advised.

[jwichmann]

I take Ambien occasionally for sleep issues. While it is strong, it works well and quickly with no special efforts. The key is short term use only.

[Merryfield]

I would be wary of any med that reduces your immunity. I had to have chemo and reduction of white blood cells made some weeks scary, as in not being able to have anyone in your house. What about a gradual reduction in the steroid and adding half an ambien or a trazodone tab?

[PMRpro Ambassador in reply to Merryfield]

The medications and doses we take for PMR rarely have anything like the effect on WBCs that chemo does. Actemra has had no effect on my immunity - still rarely get a cold!