Using Kevzara to taper down from prednisone

@cwbf 12.5 mg is a high dose for adrenal insufficiency to start. It is more typical at 7 mg or lower. I just googled how long it takes Kevzara to work, and it said it can take up to 3 months to have full effect. So I suspect your PMR is not currently controlled by 12.5 mg of prednisone.

"How can you tell if it's PMR or adrenal insufficiency?"

You probably won't know if the goal of treating PMR is to have "no pain." In essence, all pain becomes PMR pain if you think that way. I'm not saying you think that way. You just need to be very astute at deciding if it is PMR pain or not. I wasn't very good at deciding what pain was PMR and what pain was something else.

Your first question is a good lead to the next question.
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"How do you know the Kevzara is working?"

I started believing that Actemra was working when it was easier for me to taper my prednisone dose lower. I assume Kevzara is the same. When I reached 3 mg of prednisone, I was in uncharted waters because I was never able to taper my prednisone dose that low no matter how slowly I tapered.

My ability to taper prednisone after Actemra was started was different. I went slowly for the first 3 months on Actemra but then I was able to taper rather quickly.

I had some pain but it wasn't the same as what I attributed to PMR. At 3 mg, I was instructed not to taper any lower because my cortisol level was too low. When an endocrinologist was consulted, I was told to expect some pain with adrenal insufficiency but I shouldn't increase my prednisone dose unless the pain was intolerable. The pain wasn't as bad when I expected some pain but my overwhelming fatigue seemed intolerable.

Some people say Tylenol helps prednisone withdrawal pain but I never tried that. I was guilty of treating all of my pain with prednisone ... I guess.

I think biologics work quietly behind the scenes and it is harder to tell if they are working or not. The pain relief I experienced from Actemra wasn't like prednisone when the pain relief occurred rapidly but didn't last for more than 24 hours. The longer I was on Actemra without a flare ... it convinced me that Actemra was working.

I think it is better to treat PMR with something that lasts longer instead of taking prednisone which for me only lasted for one day at a time.

This I have been successful with Kevzara, yes, took 60-75 days to kick in, don’t recall. Thrilled with it and it helped me get off prednisone.
Your prednisone taper seems quite fast. I was told not to taper more than 10% per taper. That might explain pain level. I used the alternating method, 13 day 1, 12 day 2, 13 day 3, 12 day ..4 etc. That made it 12.5. Do you split your dose, some at bedtime?
Hump days I took Tylenol for,Arthritis as a band aid (dr ok) and it helped.
. 79yo female started in Dec 2023, just hit my 2 yr mark and am on the other side of it now.
I did start my prednisone taper at abt 8 mg when I was on Kevzara. And I self tapered slowly……if not pain freee, I did not start the next taper, until pain free.
Suggest keeping a daily journal of pain level at wake up, drugs, activity, and weather.
Hang in there

Thank you all. Most helpful. Doctors dont know these things do they?

@jeff97 Thank you. After one year on this journey I am eager to get off the 'roid but you are right about the timing for Kevzara and I will be more patient.