According to Johns Hopkins Rheumatology website, "There is no “safe” dose of prednisone. Prednisone over time increases the risk of cardiovascular disease, osteoporosis and infection. It can worsen underlying diabetes and HTN. The effects are dose related– higher the dose, the worse the side effects. Prednisone use should be minimized. A dose of 5 mg daily use to be considered acceptable, but current thoughts are to try to eliminate completely." https://www.hopkinsarthritis.org/ask-the-expert/prednisone-how-much-is-too-much.

My personal experience supports this statement. After 3 months of prednisone therapy (decreasing from 17 mg to 6 mg), the bone density in my spine has been reduced by 10%, my current glucose level (which was previously normal) puts me in the "pre-diabetic" camp, my bad cholesterol level (which was previously normal) has increased by 50%, I have a "moon face" and fat has accumulated on the back of my neck. I haven't gained weight.

I started on Kevzara in early January and have tapered from 13 mg to 6 mg prednisone. My insurance company approved Kevzara ( that otherwise costs about $4,500 per month) after I had a major PMR relapse during an attempted prednisone taper.

My understanding is that there are studies of other drugs that may make it possible to avoid using steroids to treat PMR. A recently completed phase 2 study in France (found on PUBMED, the NIHs electronic database) involves a new drug that was tested on prednisone naive patients. The results were very promising. I hope that Kevzara's manufacturer does a similar Phase 3
study. Currently, prescribing Kevzara before prednisone fails is an "off label" use - and even decent health insurance companies will avoid paying for expensive biologic drugs by stating that the use is "off label." (Btw. I was shocked to read on United Healthcare's website that its drug plan does not cover drugs that the patient self-injects - which cleverly allows the plan to exclude payment for Kevzara and other biologic drugs).