If you have tapering problems below 5 mg this might explain why.

Some people would say Kevzara does nothing to directly improve your cortisol level if you have prednisone induced adrenal insufficiency. I would say there is an indirect effect that helps.

Hopefully, Actemra or Kevzara will allow you to taper your Prednisone dose to 3 mg and still prevent a flare of PMR. Being able to stay on 3 mg was the magic dose that allowed my cortisol level to improve. That 3 mg dose of prednisone was a low enough dose for my adrenals to get a strong signal to produce cortisol again.

Adrenal insufficiency from long term prednisone use can persist for a long time. My endocrinologist told me to be prepared to stay on 3 mg of prednisone for "as long as it takes" for my cortisol level to improve. I was only able to stay on 3 mg of prednisone without a flare of PMR because of Actemra. In my case, my cortisol level improved after 6 months. For some people it won't be that long but for other people it might be much longer. I felt awful on 3 mg of prednisone but at least I didn't have a PMR flare.

What usually happens, is that patients taper their prednisone dose lower only to have a flare of PMR. The dose of prednisone at which flares happen is disproportionately around 7 mg which is approximately the dose where our bodies can sense a low cortisol level. Typically a flare of PMR happens and prednisone is increased only to suppress adrenal function some more. Without Actemra, I would never have been able to maintain a 3 mg dose long enough to allow my adrenals to recover some of their function.

After I stopped Prednisone and remained on Actemra alone, my adrenals made a full recovery. The advantage that Actemra and Kevzara have over Prednisone is that these medications can control PMR and GCA without suppressing adrenal function.

The "prednisone deal with the devil" we make happens when our adrenal function gets suppressed. In essence, we replace cortisol with prednisone. The deal results in adrenal suppression and it is difficult to undo this deal.

Artificial intelligence says the following:
"The idea of the "prednisone deal with the devil" is a metaphor for the serious risk of adrenal suppression that comes with corticosteroid use. When you take prednisone, a powerful synthetic steroid, your body no longer needs to produce its own natural stress hormone, cortisol. This effectively "replaces" your natural cortisol with the drug."
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Unfortunately, adrenal insufficiency is the devil we live with when we take long term prednisone..

I wasn't enrolled in this study but my experience with Actemra mirrors the results of the study. No reason to believe that Kevzara wouldn't work for some people as well but maybe not everyone.

Actemra and Kevzara both inhibit IL-6, so both should help with PMR for some people. I'm starting to understand that IL-6 is an inflammatory substance and also an inflammation controller. If a drug inhibits IL-6, it also inhibits other sources of inflammation that are controlled by IL-6. Inhibiting IL-6 is both good and bad for people with PMR and GCA. It reduces the autoimmune response that is attacking the body's tissues, but it also reduces the body's immune response against infections and vaccines. I've read that people vary as to how much of their inflammation is generated by IL-6 vs other inflammation pathways, so that determines if Actemra or Kevzara will be effective against their disease.

I have stopped thinking about "single inflammation pathways." It seems more like an inflammation network that is tightly regulated by the body. There is a lot of action and reaction happening. My rheumatologist explains it with upstream and downstream regulation of one pro-inflammatory cytokine action and another anti-inflammatory cytokine reaction. Then there are some cytokines with both pro and anti inflammation effects. I will never understand this network but it seems like cortisol is the primary hormone that regulates inflammation.

Artificial intelligence seems to agree:

"That's an excellent way to describe the complexity of the immune system and the challenge of understanding it. Your rheumatologist's explanation captures the current understanding: a sophisticated network of signaling molecules (cytokines) that regulates inflammation, with cortisol acting as a key hormone to keep the system in check."
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In any case, prednisone seems to throw a wrench into the entire inflammation network system and disrupts everything the body does.

I like artificial intelligence because it is generally agreeable but it has no qualms about disagreeing. It expresses itself better than I can.

"Prednisone, a potent corticosteroid, acts broadly to suppress inflammation and the immune system, affecting numerous bodily functions and leading to widespread side effects. By mimicking the natural stress hormone cortisol, it throws a wrench into the body's entire regulatory network, not just the inflammatory response."
🤔

I suppose Actemra and Kevzara can also disrupt the inflammation network and immune system but hopefully not to the extent that Prednisone does. At least my rheumatologist thinks so and neither Actemra or Kevzara suppresses the production of cortisol by the adrenals.

According to artificial intelligence:
"The statement is accurate: Neither Actemra nor Kevzara directly suppresses the production of cortisol by the adrenal glands. Instead, they are interleukin-6 (IL-6) inhibitors that help reduce inflammation, which can allow patients to gradually reduce or stop their use of corticosteroids (like prednisone)."
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I just get a chuckle with some of this stuff. When I was on another PMR forum, a "self proclaimed" PMR expert who was "entitled to know" because of having PMR and taking Prednisone for a long time said "Actemra was dangerous" because of the potential side effects compared to prednisone and "cortisol had nothing to do with it." This person also said my rheumatologist was ignorant and was breaking the rules for prescribing Actemra to me.

It is hard to know what to believe. My rheumatologist was right to say I wouldn't know unless I tried Actemra to see if it works or not.

I do think that Actemra and Kevzara are dangerous. I mentioned recently on this forum that on my patient chart at my rheumatologist, under problems it lists "use of a high risk drug Actemra". You have to assess the risk of Actemra or Kevzara against the benefit to your quality of life of getting off of prednisone. Since I will need to be on a medication for several years to treat my GCA, it makes sense to take Actemra and not take prednisone. But if you're on a relatively low dose of prednisone and hope to be off of it at some point, it might make more sense to not take a biologic drug.

I do think that Actemra and Kevzara are dangerous. I mentioned recently on this forum that on my patient chart at my rheumatologist, under problems it lists "use of a high risk drug Actemra". You have to assess the risk of Actemra or Kevzara against the benefit to your quality of life of getting off of prednisone. Since I will need to be on a medication for several years to treat my GCA, it makes sense to take Actemra and not take prednisone. But if you're on a relatively low dose of prednisone and hope to be off of it at some point, it might make more sense to not take a biologic drug.