PMR: Are there treatment alternatives to Prednisone?

Posted by ronhonn @ronhonn, May 20, 2020

Hi, all. I'm wondering if anyone is finding any alternatives to Prednisone in treatment of PMR?

I've been on the PMR/Prednisone train for about 6 months now (was in pain and stiffness for a year or two before but just thought I was "getting old"), being treated through Rheumatology at Shands Hospital (Great people, like Mayo, I'm sure.) in Gainesville, FL. I started at the high dose of 60 mg, it was amazing--within days I felt like I was invincible, having delusions of grandeur due to "Prednisone Psychosis" (It's a thing. And I ride it for all it's worth. 🙂 )
--and launched into crazy lucid dreams and auditory hallucinations--honest to God, one night I heard Wolf Blitzer from CNN standing at the foot of my bed and in a clearly audible voice say: "Right." -and I was up for the night and most nights after. In fairness to my brain, I watch The Situation Room sometimes, so I should've seen that coming.

I was only sleeping, like 1-2 hours a night, but had incredible energy. My nocturnal meanderings included a voracious appetite--for which I tried to stave off weight gain by eating large quantities of vegetables. My wife refers to me as "The Were-rabbit", with appropriate emojis. And with my morning evacuations I could fertilize half of England. I've retained fluids to the point that I look kind of like a squirrel with a mouthful of acorns? Only without the benefit of said nutritional content. I look like--if Alfred Hitchcock and Winston Churchill had a love child? I would be that child.

These days, I've tapered down to 15 mg/day, and the pain and stiffness are returning. Now I look like Winston Churchill/Alfred Hitchcock (Where did my chin go? I distinctly remember having a neck.), only I'm dragging out my cane again (Okay, that's a little Churchillian, at least) to get up and move around.

If I sleep 5 hours at a stretch, I call that:
"Boy, I'm sleeping the whole day away!"

Fortunately for me, I'm teaching remotely via Zoom, and my students are all so kind as to not ask what happened to my chin. Some days, I can't even remember if I was wearing pants. They love me for the madman that I am.

As I consider increasing dosage and heading back into Prednisone Psychosis land, I wondered if there's an alternative to allow me to hop off the train?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@wilmingtonemperor

dadcue; I know that this is long term and at 82 the side effects long term use of prednisone probably will not matter. However, my brother,79, has been on prednisone for 20 years for RA and his kidneys are shutting down. My brother-in-law, also 79 and a former long haul truck driver has also been taking prednisone for RA for 20 years and his adrenals have shut down permanently. So you have my admiration for dealing with this for more than a decade. I feel really fortunate that Kevzara was approved for PMR within week of my diagnoses and that I was able to get on it within 9 months. Now we wait to see what happens.
Stay well; John

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Why were your brother and brother-in-law treated with prednisone for so long? I thought prednisone was only used short term for the treatment for RA flares but not used anymore as a long term treatment for RA.

I think it is great that you were prescribed Kevzara so soon. I did reasonably well on prednisone. I took it willingly even though I acquired other medical conditions which were "prednisone related."

I don't regret taking prednisone for as long as I did. My only regret is that I wish Actemra was tried sooner.

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@wilmingtonemperor

I was diagnosed with PMR on Jan 25 of last year. Today, Jan 9, 2024 doc has taken me off prednisone entirely to see if Kevzara can carry the whole load. I took my last (hopefully, 2.5 prednisone) this morning. I have had 6 injections of Kevzara and his position is that the biologic is fully active in my system. Needless to say I am delighted to be off prednisone at age 82. I feel absolutely fine all things considered and really think that prednisone is in the rear view mirror while realizing that PMR is chronic and may rear up again. There are alternatives to prednisone for the long haul.

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To Wilmington Emperor.
I am still waiting to see if I have been approved for financial assistance for Kevzara. I am so encouraged to know that you had such good results. I’m curious if your 6 injections were over a three month period. Is the plan to stop the Kezvara or do you just reduce the number of injections over time to hopefully get off of that too? I remember you said you were taking 20 mg when you started Kevzara so it’s impressive that you were able to get to 0mg (Jan 9) with the help of Kevzara.

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@harelover

To Wilmington Emperor.
I am still waiting to see if I have been approved for financial assistance for Kevzara. I am so encouraged to know that you had such good results. I’m curious if your 6 injections were over a three month period. Is the plan to stop the Kezvara or do you just reduce the number of injections over time to hopefully get off of that too? I remember you said you were taking 20 mg when you started Kevzara so it’s impressive that you were able to get to 0mg (Jan 9) with the help of Kevzara.

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Hi harelover; so the Kevzara was over 12 weeks starting in October. My 7th injection will be next Tuesday, Jan 16. I am very fortunate that as a retired military I have a very manageable co pay for a 2 month supply(4 injector pens) that is delivered by FedX in a cold pack overnight. IO don't know what the next step is at this time. I think it depends on whether there is any negative reaction to no more prednisone. If Kevzara ends up being a maintenance drug over time, so be it. My doc has really been on top of the whole situation since I was diagnosed. He is my PCP and not a rheumatologist. So good luck and stay in touch.
John

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@wilmingtonemperor

Hi harelover; so the Kevzara was over 12 weeks starting in October. My 7th injection will be next Tuesday, Jan 16. I am very fortunate that as a retired military I have a very manageable co pay for a 2 month supply(4 injector pens) that is delivered by FedX in a cold pack overnight. IO don't know what the next step is at this time. I think it depends on whether there is any negative reaction to no more prednisone. If Kevzara ends up being a maintenance drug over time, so be it. My doc has really been on top of the whole situation since I was diagnosed. He is my PCP and not a rheumatologist. So good luck and stay in touch.
John

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Got it! Good luck with being Predisone- free. I hope that others with experience with Kevzara will post here as well since it’s so new for PMR treatment. Keep us informed.

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@harelover

Got it! Good luck with being Predisone- free. I hope that others with experience with Kevzara will post here as well since it’s so new for PMR treatment. Keep us informed.

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There are quite a few other discussions where member have shared their experience with Kevzara you might also find helpful. Here is a list of the different discussions using a search of Connect for Kevzara - https://connect.mayoclinic.org/search/discussions/?search=Kevzara.

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