Switching From Prednisone to Methotrexate!?

Posted by coachmike @coachmike, Aug 14 6:14pm

I was diagnosed with PMR 10 years ago and have been on low dose Prednisone (5mg) ever since. Flares happen about once a year on average, are blasted with 25-30 mg of Prednisone for a few days and then tapering takes place until back down to 5. I have also come right off the pred for stretches of time in years past. Works quite well. My rheumatologist has asked me to consider coming off the pred (long term side effects) and switching to methotrexate but I keep reading nasty things about it. Is this the route to go? Are there other drugs out there that may be just as effective yet not frowned upon so much? Feedback welcome.

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hammock117 | @hammock117 | Aug 15 7:15am

Methatrexate works well for me. Gradually increased to 7 2.5 mg

jeff97 | @jeff97 | Aug 15 7:25am

Kevzara is probably more effective and also probably has fewer side effects. It depends on the person. I take Actemra to control GCA and PMR. Actemra is similar to Kevzara, as both are biologics that control IL-6, a major source of inflammation. I haven't had any side effects from the Actemra, which I have been taking for a year. Also it has allowed me to get off of prednisone. You would have to check to see if Kevzara is allowed by your insurance.

seniormed | @seniormed | Aug 15 7:41am

Actemra and hydroxychloroquine are options.Go slow on taper down from
prednisone as you are likely to be adrenal suppressed for a time.
A Dexascan is indicated. I am convinced an anti inflammatory diet
and cardiovascular risk assessment should be part of disease management in PMR.

gmdb | @gmdb | Aug 16 4:17am

Methotrexate can work really well for some people with PMR, but I think recent research shows it is "only some" and not most. It won't replace steroids but may allow you to taper at a faster rate if it works for you. I got some benefit from it initially but after 12 months it seemed to stop working and over the following 6 months I developed toxicity to it which resulted in a number of very bad side effects, and hospital admissions to treat them. Stopped taking it 8 weeks ago and the side effects have ceased but the methotrexate toxicity caused the PMR to flare and I am on a higher dose of steroids again. I have heard that Actemra is a more successful treatment, but methotrexate is cheaper and depending on your health care system, insurance, etc you may need to try methotrexate and have that treatment fail before Actemra will be approved and funded.