I wanna stop taking methotrexate and prednisone.

@claudette2024

I have multiple autoimmune disorders including PMR but not GCA.

Actemra works in the same way that Kevzara works. Actemra was the first IL-6 inhibitor and has been used for RA and other autoimmune disorders for a long time. Actemra was FDA approved for GCA in 2017. I started Actemra in 2019 before Kevzara was FDA approved for PMR. My rheumatologist believed that Actemra "should work" for PMR after research showed that it worked for GCA.
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" The high cost of clinical trials combined with the availability of lower-cost biosimilars for Actemra makes it an unlikely path for the drug's manufacturer, Genentech, to seek FDA approval for polymyalgia rheumatica (PMR). "

It is doubtful that Genetech will seek an additional FDA approval for PMR because it costs so much money to do the clinical trials to get FDA approval. Since Actemra is no longer patented, there are already biosimilars on the market that compete with Actemra at a lower cost. Research and development costs for medications to get the initial FDA approval for a specific diagnosis are astronomical.

@dadcue
Thank you.
My rheumatologist is leaving the decision up to me.
Methotrexate or Kevzara or Rincoq. She did not mention Actemra. After a year of pred I need to get off. My body looks like a war zone.

I wish you luck with whatever you decide.

Rinvoq is the latest modern treatment for GCA that was FDA approved very recently in April 2025. If Actemra stops working for me I would likely be switched to Rinvoq. It is also FDA approved for some of the other autoimmune disorders that I have.

You must have a good rheumatologist. She is aware of the latest treatment options that are available. Rinvog works differently compared to both Actemra and Kevzara. It comes in pill form so no injections or infusions.

Any of these medications might work better than methotrexate. Sometimes insurance companies require that methotrexate be tried first before approving the more expensive biologics.

I think good rheumatologists want their patients off Prednisone as soon as possible. These alternatives to prednisone for PMR/GCA are seen as steps in the right direction.

I quit taking Methotrexate a year ago, but continue my tapering of Prednisone. I'm now at 5 mg Prednisone. I will begin tapering 1/2 mg per 4 weeks. I'm hoping this slow tapering works.

I am on methotrexate and prednisone too. My doctor had me on 10 mg of prednisone daily and 20 mg of methotrexate once a week. I have been reducing the prednisone by 1 mg every two weeks and I am down to 6 mg right now. I feel great. I should be off prednisone if everything goes well in December. About two months ago I started feeling good enough to walk and hike. I am increasing the distance and hills gradually but still feeling good. I think the exercise is helping me a lot. I wish you the best however you proceed!!

@farnhamlaf1 By all means take some turmeric but fresh is better than capsules, or organic dry powder is also good, and preferably in cooking were it is absorbed slowly with other healthy nutrients from food. People have gotten turmeric toxicity from taking too many of the capsules too quickly. Does it work? It does help with general inflammation and contributes to good health. But PMR is a big illness with very specific inflammatories bombarding your system - turmeric or any of the other supplements (like rose hip vital) are unlikely to help much. I was on a low inflammatory diet which included lots of turmeric for 3 years prior to PMR hitting. It didn't stop the PMR from turning up, and increasing the amount of turmeric in the diet hasn't helped since, nor rose hip vital or the other anti-inflammatory supplemnts I have tried.

Methotrexate may take longer than 14 weeks to work and it doesn't work for many who have PMR. Recent research has suggested it is not really worthwhile. But it does work for some so it's why we give it a go. Watch carefully for side effects from methotrexate and perhaps reach an agreement with your doctor on a time limit for seeing if it does any good. In my case I ended up in hospital very ill from methotrexate toxicity. My doctor had way too much faith in it being a miracle drug, because he had one PMR/GCA case were it worked successfully.

Has anyone tried Naltrexone in low dose 2.5mg daily
Or hydrocortisone 5mg

@dfal29 I have not tried either. I have gca and pmr for 4.5 years down to 2.5mg but still elevated crp and in think pmr soreness. Dr wants me to go on methotrexate and I don't want that. I did have 19infusion of actemra but didn't seem to work as I had a couple major flares while on it and my cholesterol shot up to 300, also fatigue.

How has your experience been on methotrexate and how long have you been on it

I stopped taking my methotrexate. I didn’t think it was doing anything. I’m down to 6.5mg of prednisone. I’m a little stiff in the morning, but as the day goes on, it’s less than less mostly down around my pelvic area and behind my knees I’m gonna keep trying to reduce by half that seems to be better than reducing by a hole, any other thoughts?

@farnhamlaf1 As they say in Spain, "poco a poco." A little bit at a time. I started my treatment for PMR at 15 mg. of prednisone every day. After a month or so, the rheumatologist wanted to also put me on methotrexate, but I felt the potential side effects (given my history) were not worth the risk.
That was three years ago this October. Every time I tried to reduce the prednisone by more than 1.25 mg (typically after 2-3 months) I had a serious flare which took 15-25 days to get the pain and mood swings back under control.
I now live in a different city with a new rheumatologist. He is much more conservative in reducing the prednisone. I'm now alternating between 2.5 mg and 1.25 mg every other day, since August 1. I'm just now getting over the terrible mood swings that I get when reducing, although this time the body pain has been much less than other times. I do believe that with prednisone tapering, slow but steady wins the race. ...as long as you don't have any other complications from taking long-term prednisone, that is!