When to taper prednisone when starting kevzara

Posted by ronludington @ronludington, 4 days ago

I have had 2 doses of kevzara, the 3rd going in in 3 days. I was feeling pretty good , thinking maybe this kevzara is kicking in early .. (nope) I was on 10mg of prednisone . My rheumatologist said go down to 7.5 after a month on kevzara. So a week after the 2nd dose, I dropped to 7.5. First 2 days we're no problem, the 3rd day, I woke up to feeling like being run over by a truck. I couldn't wait to get that 7.5 in me. A couple hours later I started to feel better. So, I'm assuming withdrawl. Today (a day later) not so bad, (but not good either) but if kevzara takes 3 months to kick in fully, shouldn't we start our taper a little later into the process, maybe after the 4th shot ? (I'm on the 200 every 14 days protocol)

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

Mike | @dadcue | 4 days ago

Kevzara only treats the inflammation caused by PMR. I suspect you are feeling withdrawal symptoms. Withdrawal symptoms may be a few days or they may persist for a long time.

IF your adrenals are suppressed, you will still need to taper your Prednisone dose slowly when on Kevzara. The degree that your adrenal function is suppressed depends on many factors.

Approximately 7 mg is when people begin to feel Prednisone withdrawal symptoms. The reason people feel withdrawal symptoms is because their adrenals are suppressed.

While 7 mg is often cited as a critical point in the tapering process, especially for those on prolonged prednisone therapy, the withdrawal symptoms and the rate of tapering depend on individual factors. For some patients on long-term prednisone, symptoms of adrenal insufficiency may only appear when the dose drops below 5 mg per day.

We are all different. I took Prednisone for 12+ years until Actemra was tried. Kevzara should work similarly to Actemra. From 10 mg, I tapered by 1 mg per month for the first 3 months while I did Actemra injections every 2 weeks. When I reach 7 mg. I tapered by 1 mg per week until I reached 3 mg.

When I was on 3 mg I felt significant withdrawal symptoms. It was confirmed that my cortisol level was low. I needed to stay on 3 mg for 6 months until my cortisol level improved. Once my cortisol level improved, an endocrinologist said it would be safe to stop Prednisone. Apparently, 3 mg is a small dose according to my endocrinologist. She said there was no need for me to taper from that low of a dose as long as PMR was under control.

This is what I did --- my personal experience only --- listen to your doctor before listening to me. There is no single correct way to taper off prednisone. There's also a chance that Kevzara might not work at all. My rheumatologist offered no guarantees that Actemra would work for me but it did. I was able to taper off Prednisone but it still took me a year. Most of that time was due to adrenal insufficiency because of being on Prednisone for 12 + years.