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How to Slowly and Safely Taper Off Prednisone but ... no set rules.
Polymyalgia Rheumatica (PMR) | Last Active: 5 days ago | Replies (70)Comment receiving replies
in reply to dadcue.
My rheumatologist and I agreed in August that I had a full relapse. We started at 20 mg and worked down. He prefers a faster taper, but it has failed three times since August. I've just moved back to 20 mg for two weeks, and then I'll move to 15 mg until our appointment in April. My last failure was at 7 mg—so close, yet so far. Hopefully, I'll reach 5 mg on the next taper.
So, what if I can't get to 5 mg? Well, in 2019-2021, I eventually got to 0 mg and was symptom-free for almost three years. I believe I can get there again. However, if I get stuck at the 6-7 mg level for a year or so, I'll probably agree to adding Actemra.
Replies to "in reply to dadcue. My rheumatologist and I agreed in August that I had a full..."
Below 20, I tapered at 2.5 every two weeks to 10, then at 1 per month to 5.
No problems.
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"My last failure was at 7 mg—so close, yet so far."
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I used to think it was "my failure" when I was unable to taper off prednisone. When I took steroid sparing medications ... it was always the steroid sparer that failed and it was discontinued.
I started asking myself why prednisone never failed. When I read the following report I started to realize prednisone does fail. It all depends on one's perspective.
https://www.healio.com/news/rheumatology/20190405/prednisone-tapering-fails-in-most-patients-with-giant-cell-arteritis
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With this in mind ... I don't think it is the tapering method that fails and doesn't work. There has never been a tapering method that has been researched that works well except maybe a slow taper is better. Maybe a slow taper gives PMR/GCA more time to "burn itself out."
Tapering slowly is because of the problem with adrenal suppression and not necessarily disease control. It seems to depend more on what people consider a "success' to be.
A personal success, a treatment success, a tapering success and even whether or not taking Prednisone forever is a "symptom management success" are all different ways to think about success.