Weight based prednisone dosing

@groksvaag, I think you are correct but I have no medical experience other than having PMR twice, and both times I started at 20 mg prednisone. Not sure what my body weight was but probably about 250 to 260 pounds at the time. Here's an article from 2011 that supports what you mentioned.

-- The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity: https://link.springer.com/article/10.1186/1471-2474-12-94

You might find this discussion with some references started by @dadcue helpful:
-- How to Slowly and Safely Taper Off Prednisone but ... no set rules.
https://connect.mayoclinic.org/discussion/how-to-slowly-and-safely-taper-off-prednisone-but-no-set-rules/

"Therapy is based on empiric experiences because few randomized clinical trials are available to guide treatment decisions."
https://emedicine.medscape.com/article/330815-treatment
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My rheumatologist initially told me to "find a stable dose of prednisone that worked to control my PMR symptoms." My 40 mg starting dose was symptom based and not weight based. I was also 6 feet 3 inches and weighed about 250 lbs.

I gained more than 50 pounds while I was on prednisone. My dose was never increased because of my weight gain. Sometimes my rheumatolgist used my inflammation markers (CRP and ESR) to justify an increase in my dose but mostly it was symptom based.

I was treated with Prednisone for 12 years before Actemra was tried. PMR was refractory and I was still on 10 mg of prednisone. I was able to taper my Prednisone dose more rapidly after Actemra was started. Symptoms of adrenal insufficiency and a low cortisol level required me to stay on 3 mg of prednisone for 6 months before I was finally able to discontinue prednisone

I have been on Actemra for 6 years and off Prednisone for almost 5 years. Actemra works well for me.

Good luck with Kevzara!

I agree. I’m 77 as are several friends and over the years my friends who weight 50 pounds less than me take half the dose I do of even the over the counter drugs like Tylenol or ibuprofen. At least for maintaining but imitating they may take full dose

Basically all guidelines go along with fixed doses
recommended to start based on clinical experience in adult patients for PMR. The literature and associated
society guidelines have consistently recommended set
dosing requirements which are not weight based.
As a physician you can have access to the App:
“OPEN EVIDENCE” OE that is sponsored by JAMA
and NEJM to do AI literature searches for clinical questions on patient management.

Thanks for all the responses. I had previously seen article showing initial dosage to control varied with weight but have not seen studies looking at dosage by weight over time Clearly there is significant variability in dose needed to "control symptoms" over time even for those of same weight.

Hi @groksvaag, I was prescribed 40 mg prednisone for Giant Cell Arteritis. My Rheumatologist said the dosage was appropriate, given my size - 4'11" and under 100 lbs.

Much higher doses needed for GCA than PMR. Prednisone dose for GCA is weight based with a maximum. PMR dosing is done regardless of weight although the one study did show heavier patients might require higher dose when treatment started after initial diagnosis.

It's possible to experience both polymyalgia rheumatica (PMR) and inflammatory arthritis concurrently. This was mostly my problem. Multiple autoimmune conditions along with other non-autoimmune problems explain my higher starting dose and longer duration of being on Prednisone. GCA was never my problem. My size might also have justified a higher dose.

The general overriding principles for taking prednisone are the "lowest effective dose" and the "shortest duration possible."

After long term Prednisone use, the problem with secondary adrenal insufficiency needs to be considered.