Prednisone taper with Kevzara

[LCHRISTOP10]

75 year old. Dx PMR 2016 CRP 72. Treated with steroids and tapered. Dx GCA by temporal BX 2018. Breast Ca 2019 lumpectomy and radiation. Continued steroids intermittent mild flairs. April 2024 major flare difficulty lifting arms and other stiffness and discomfort. Very tired. Pred was 4.75. . Eventually Rheumy increased Pred to 15 mg and tapered. Started Kevzara in July 2024. Injection every 2 weeks. Pred dose now alternating 6 mg and 5.75 mg. Now that Kevzara fully activated , any recommendation how fast to taper? I usually decrease by .25 mg alternate with higher dose 4 times. Stay at new dose couple of weeks along as I feel ok. Recent non COVID resp infection without need to increase dose. See Rheumy in December after labs.

[PMRpro Ambassador]

I would continue as you are - for 2 reasons.

Just because the Kevzara is fully activated doesn't mean that all the inflammation is fully dealt with. GCA definitely and PMR probably have more than one underlying cause of the inflammation but Kevzara only works against one, that due to the cytokine IL-6. Biologics are very specific. Half of patients have inflammation due to the other causes so half of patients continue to require some pred for the other inflammation.

The other has nothing to do with the Kevzara. You have been on pred for a long time at a dose that was enough to have suppressed adrenal function or at least not encourage return of adrenal function, Once you get to about 5mg pred, your adrenal glands must start to wake up and start to produce cortisol to top up the falling pred contribution. That takes time. The studies were mainly done with new patients who hadn't been on pred for very long and it is said that the relationship between being on pred and return of adrenal function is about a month to a month - up to about 9-12 months, i.e. if you have been on pred for 4 or 5 months, it will take about 4 or 5 months for adrenal function to return. That applies up to about a year - but then even if you have been on pred longer than a year, it tends to only take about a year for adrenal function to return. They claim - some of the members here would disagree!

[LCHRISTOP10 in reply to PMRpro]

Thank you for your informative response. I am lucky FDA in US has approved Kevzara for PMR and my insurance covers the cost. My rheumatologist has been flexible with my taper. I hope that continues.

[PMRpro Ambassador in reply to LCHRISTOP10]

If you taper the pred and don't develop fatigue or other adrenal insufficiency symptoms you may well be able to taper faster. But it is as well to be prepared for the alternative scenarios. You really do have to suck it and see. Your body will tell you - just don't ignore it!!

[Sandmason in reply to LCHRISTOP10]

Those of us over 65 on Medicare can only get them to pay for Kevzara if we get it in the doctor's office, mostly now infusion centers, the new side gig for rheumatologists. I wonder who lobbied for that distinction? The AMA? Here we cant get to a rheumatologist and I doubt my GP can get it. I have diverticular disease so it's contraindicated for me anyway. No one needs a colon rupture.

[Paulagcl]

Lots of advice on here about tapering -- whatever works for you. I went back and forth a little but with Kevzara, am completely off prednnisone.

[LCHRISTOP10 in reply to Paulagcl]

How long after off Pred did you cont Kevzara?