Successful (so far) approach to a super slow taper

I have suffered from PMR since 2019, first starting treatment in February 2020 at 20 mg of prednisone, which was immediately effective, and I subsequently struggled with the taper for five and a half years, getting down to 1 mg, or half a mg, then going cold turkey, only to have the pain return within a week. In June 2023, on my rheumatologist’s recommendation I relaxed about it, went back up to five mg. and started what I hoped was a final taper. I did the usual slow drop, half a mg at a time through August of 2024, coasting for long periods of time at 2 mg. In September of 2024, after reading about the effectiveness for people of a super slow taper, I decided to do that, but approach it a bit differently. Instead of looking at a consistent drop on a daily basis (down .25 or .5 mg per day), I came up with a plan that looked at my weekly dose, and then did a consistent percentage drop in the total weekly dose over time. I reasoned that doing a normal taper, where you are taking the same dose every day, the .25 or .5 daily reduction becomes a larger and larger percentage drop in the total dose over a week, making it too fast.

When I started the taper, from 2 mg a day in September 2024, or 14 mg a week, my first drop was to 13 mg a week: 1.75 mg, three days a week, and 2 mg 4 days a week. That represented a 1 mg drop over the week, or 7%. I held that dose for six weeks.

I continued that way, spreading out an approximate 8-15% drop per week over the week (example, second taper after six weeks was to 12 mg total (6 days at 1.75 and one at 2 mg), an 8% drop in the weekly dosage. My final taper was in mid-July of this year, where I was down to 4.5 mg a week (4 days at .75, and 3 at .5 mg). In late July I had cataract surgery, and after a week realized that I was doing the steroid eye drops at the rate of 3 mg of prednisone a day! Since I felt relatively pain free, I decided to stop the oral prednisone completely, and I never picked it back up.

I am two months post taper and, knock on wood, I am in remission. I will never say never because this condition is really a bear, but I think that there is really something to a taper that is SUPER slow, with consistent percentage drop in the weekly total dose.

This approach means you have to have a good pill splitter and not mind using it. I never went smaller than .25 mg, which is pretty tiny with the 1 mg pills, but it seems to work. I have attached what I came up with in an excel spreadsheet. I hope it helps someone out there!

Ann Metcalfe