Weight based prednisone dosing

@groksvaag, I think you are correct but I have no medical experience other than having PMR twice, and both times I started at 20 mg prednisone. Not sure what my body weight was but probably about 250 to 260 pounds at the time. Here's an article from 2011 that supports what you mentioned.

-- The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity: https://link.springer.com/article/10.1186/1471-2474-12-94

You might find this discussion with some references started by @dadcue helpful:
-- How to Slowly and Safely Taper Off Prednisone but ... no set rules.
https://connect.mayoclinic.org/discussion/how-to-slowly-and-safely-taper-off-prednisone-but-no-set-rules/

"Therapy is based on empiric experiences because few randomized clinical trials are available to guide treatment decisions."
https://emedicine.medscape.com/article/330815-treatment
-------------------------
My rheumatologist initially told me to "find a stable dose of prednisone that worked to control my PMR symptoms." My 40 mg starting dose was symptom based and not weight based. I was also 6 feet 3 inches and weighed about 250 lbs.

I gained more than 50 pounds while I was on prednisone. My dose was never increased because of my weight gain. Sometimes my rheumatolgist used my inflammation markers (CRP and ESR) to justify an increase in my dose but mostly it was symptom based.

I was treated with Prednisone for 12 years before Actemra was tried. PMR was refractory and I was still on 10 mg of prednisone. I was able to taper my Prednisone dose more rapidly after Actemra was started. Symptoms of adrenal insufficiency and a low cortisol level required me to stay on 3 mg of prednisone for 6 months before I was finally able to discontinue prednisone

I have been on Actemra for 6 years and off Prednisone for almost 5 years. Actemra works well for me.

Good luck with Kevzara!

I agree. I’m 77 as are several friends and over the years my friends who weight 50 pounds less than me take half the dose I do of even the over the counter drugs like Tylenol or ibuprofen. At least for maintaining but imitating they may take full dose

Basically all guidelines go along with fixed doses
recommended to start based on clinical experience in adult patients for PMR. The literature and associated
society guidelines have consistently recommended set
dosing requirements which are not weight based.
As a physician you can have access to the App:
“OPEN EVIDENCE” OE that is sponsored by JAMA
and NEJM to do AI literature searches for clinical questions on patient management.

Thanks for all the responses. I had previously seen article showing initial dosage to control varied with weight but have not seen studies looking at dosage by weight over time Clearly there is significant variability in dose needed to "control symptoms" over time even for those of same weight.

Hi @groksvaag, I was prescribed 40 mg prednisone for Giant Cell Arteritis. My Rheumatologist said the dosage was appropriate, given my size - 4'11" and under 100 lbs.

Much higher doses needed for GCA than PMR. Prednisone dose for GCA is weight based with a maximum. PMR dosing is done regardless of weight although the one study did show heavier patients might require higher dose when treatment started after initial diagnosis.

It's possible to experience both polymyalgia rheumatica (PMR) and inflammatory arthritis concurrently. This was mostly my problem. Multiple autoimmune conditions along with other non-autoimmune problems explain my higher starting dose and longer duration of being on Prednisone. GCA was never my problem. My size might also have justified a higher dose.

The general overriding principles for taking prednisone are the "lowest effective dose" and the "shortest duration possible."

After long term Prednisone use, the problem with secondary adrenal insufficiency needs to be considered.

@dadcue I could see if it was over a very short period of time, but if you gained 50 pounds over 12 years there's no way that you can tell if the Prednisone was the reason.

@diegory

My 50# weight gain was probably within the first 5 years of starting Prednisone for PMR. I was still reasonably active during this time. I complained of "exercise intolerance" within a year but that was because of being short of breath while doing 50 mile bicycle rides. I had an exercise tolerance test done and it was interpreted as "normal." My PCP wanted me to have a pulmonary function test but I declined that test since my exercise tolerance was normal.

I continued to gain weight while exercising until I hit the proverbial wall while doing one of my bicycle rides. I informed my PCP about an irregular pulse and "skipped beats" which warranted an EKG.

The EKG detected left ventricular hypertrophy (LVH). My blood pressure was normal at the time of the EKG but my PCP wanted me to check it more often. Within a week, I was in the emergency room with a blood pressure reading of 210/110. I started 3 medications to control my blood pressure.

Five years after I started prednisone, I was unable to exercise because of being chronically short of breath. I didn't think I was more short of breath when someone urged me to go to the urgent care center because I didn't look well. I was perturbed when an ambulance was called to take me to the emergency room. I would have run away but that was impossible with multiple and bilateral pulmonary embolisms. This pulmonary event was described as "massive." I didn't suspect prednisone until the intensive care doctors were outside my room speculated about what caused such a massive and "unprovoked" event. There was a lot of whispering but I heard the word "prednisone" being mentioned frequently,

I just looked at the time frame of my weight gain. I started prednisone daily for PMR in 2009. My weight increased by 40# within the first 3 years. All the cardiovascular issues were within the first 5 years. My increased weight peaked at 50# and stabilized. I told a doctor once that I didn't think it was humanly possible to gain that much weight even when I said that I stopped eating. I exaggerated but it was generally true because I made a conscious effort to not eat when I was gained so much weight.

My comorbidity list increased every year I was on Prednisone. Since getting off prednisone 5 years ago, I have lost 30 pounds. All my blood pressure medications were discontinued gradually after prednisone was discontinued along with about 5 other medication that were either treating a prednisone side effect or were prescribed to prevent a prednisone side effect.

I now try to aquacise as much as I can but a bicycle ride like I used to do is out of the question. I have rode a bike around a few blocks in my neighborhood. I was elated when I discovered that I could still swim a few laps without stopping in the big swimming pool and without having the fear of drowning.

I encountered many problems when I tried to taper off prednisone. Ultimately I was referred to an endocrinologist who determined that I had adrenal insufficiency and metabolic syndrome from long term prednisone use. I was told that it would take a long time to reverse these problems and some things might be irreversible. I'm still seeing an endocrinologist almost as often as my rheumatologist.

I took my last dose of prednisone about 5 years ago after a biologic was tried. It still took me 2 years after the biologic was started before I could taper off Prednisone completely. My comorbidity list has seen steady improvement since discontinuing prednisone except now I might have neuroendocrine tumor. This type of cancer is slow growing, unconfirmed and I'm asymptomatic. I'm worried they might have to stop the biologic I'm on.