PMR and Methotrexate

Thank you. I was at max dose of 4 a day x 2 & my doc said 2 mths should have done something. I do know it's great for RA. I will be back on prednisone for now & try the 1.5 yr advised therapy. Unless a new drug shows hope. Good luck to you!

I don't have any experience with Kevzara but there are a couple of discussions where members are discussing it here:
--- Kevzara (sarilumab) to treat PMR: https://connect.mayoclinic.org/discussion/kevzara-sarilumab-to-treat-pmr/
--- Has anyone heard this news about Kevzara approved for PMR?: https://connect.mayoclinic.org/discussion/has-anyone-heard-this-news-about-kevzara-approved-for-pmr/

I came across this article and thought it might answer a few questions on MTX. It is only one study but it is how we learn. One step at a time.

Caporali and associates conducted a multicenter, double-blind, randomized controlled trial to evaluate the efficacy of methotrexate when combined with prednisone in the wide-scale treatment of polymyalgia rheumatica.
Seventy-two patients with polymyalgia rheumatica and no contraindications to prednisone or methotrexate were given prednisone at a daily dosage of 25 mg for four weeks, tapering to 17.5 mg, 12.5 mg, 7.5 mg, 5 mg, and 2.5 mg during the following five four-week periods. In addition, patients were randomly assigned to receive methotrexate (10 mg per week) or placebo. Relapses were treated by resumption of the dose of the previous period. After 24 weeks, prednisone treatment was discontinued. All participants received a weekly dose of folinic acid (7.5 mg) 24 hours after administration of methotrexate or placebo, and daily doses of oral calcium (1 g) and vitamin D3 (800 IU). Patients were assessed regularly during the 76 weeks of the study. Medications were withdrawn from patients if there was a significant decrease in their leukocyte or platelet count or a significant increase in their serum creatinine or transaminase levels.
At the end of the study, 32 patients (89 percent) in the methotrexate group and 30 (83 percent) in the placebo group were available for evaluation. More patients in the methotrexate group were free of steroids after 76 weeks than in the placebo group, even when the worst-case scenario was assumed for those who dropped out. The efficacy of methotrexate was clear after 48 weeks, and the methotrexate patients also had significantly fewer flare-ups. Adverse reactions were not significantly different between the two trial groups.

The authors conclude that using prednisone and methotrexate together to treat polymyalgia rheumatica can decrease the number of flare-ups and reduce the total dosage of prednisone required to achieve and maintain remission. Considering the potential adverse effects of long-term prednisone therapy, this would be advantageous to all patients, especially those who cannot tolerate high doses of prednisone. Further studies are needed to determine whether methotrexate is effective as an induction therapy for polymyalgia rheumatica, and whether it can lower the initial dose of prednisone needed for treatment and control.

I came across this article and thought it might answer a few questions on MTX. It is only one study but it is how we learn. One step at a time.

Caporali and associates conducted a multicenter, double-blind, randomized controlled trial to evaluate the efficacy of methotrexate when combined with prednisone in the wide-scale treatment of polymyalgia rheumatica.
Seventy-two patients with polymyalgia rheumatica and no contraindications to prednisone or methotrexate were given prednisone at a daily dosage of 25 mg for four weeks, tapering to 17.5 mg, 12.5 mg, 7.5 mg, 5 mg, and 2.5 mg during the following five four-week periods. In addition, patients were randomly assigned to receive methotrexate (10 mg per week) or placebo. Relapses were treated by resumption of the dose of the previous period. After 24 weeks, prednisone treatment was discontinued. All participants received a weekly dose of folinic acid (7.5 mg) 24 hours after administration of methotrexate or placebo, and daily doses of oral calcium (1 g) and vitamin D3 (800 IU). Patients were assessed regularly during the 76 weeks of the study. Medications were withdrawn from patients if there was a significant decrease in their leukocyte or platelet count or a significant increase in their serum creatinine or transaminase levels.
At the end of the study, 32 patients (89 percent) in the methotrexate group and 30 (83 percent) in the placebo group were available for evaluation. More patients in the methotrexate group were free of steroids after 76 weeks than in the placebo group, even when the worst-case scenario was assumed for those who dropped out. The efficacy of methotrexate was clear after 48 weeks, and the methotrexate patients also had significantly fewer flare-ups. Adverse reactions were not significantly different between the two trial groups.

The authors conclude that using prednisone and methotrexate together to treat polymyalgia rheumatica can decrease the number of flare-ups and reduce the total dosage of prednisone required to achieve and maintain remission. Considering the potential adverse effects of long-term prednisone therapy, this would be advantageous to all patients, especially those who cannot tolerate high doses of prednisone. Further studies are needed to determine whether methotrexate is effective as an induction therapy for polymyalgia rheumatica, and whether it can lower the initial dose of prednisone needed for treatment and control.

A couple of times I posted to ask what experiences people had had with methotrexate and got limited responses. Now that I am on it I will report my experience so far. I was unable to taper below 8 mg prednisone after 20 months and my rheumatologist really wanted me to add methotrexate. The prednisone was working well with minimal side effects and my dose did not seem that high but I agreed that lower would be better as the time extends into years. I have been on the methotrexate for a month now, tapering up from 7.5 mg to 12.5, which I will stay on. I have dropped from 8 to 7 on the pred and will go down 1 mg a month. The first week I had severe side effects: nausea, headaches, a mouth sore, some hair loss. The next week was better even on a higher dose and now I just have mild nausea most of the time. I have essentially no PMR sx's. I have fatigue, but not as much as before I started the new drug. Except for the nausea I feel better. Does anyone have suggestions about how to take the methotrexate to reduce stomach problems? I take the whole dose weekly with breakfast. I'm wondering about splitting the dose or taking it either before or after a meal.