From the Guidelines
The typical prednisone dosage for Polymyalgia Rheumatica (PMR) is within the range of 12.5–25 mg per day, with a tapering regimen that aims to reduce the dose to 10 mg/day within 4–8 weeks 1.
Key Considerations
- The initial dose may be higher (up to 25 mg) in patients with a high risk of relapse and lower (12.5 mg) in those with comorbidities or risk factors for glucocorticoid-related side effects 1.
- Tapering should be individualized, with a gradual reduction in dose, and may involve alternate day reductions (e.g., 10/7.5 mg on alternate days) 1.
- Once remission is achieved, the dose can be tapered by 1 mg every 4 weeks until discontinuation, provided that remission is maintained 1.
Evidence Summary
The recommendations are based on a systematic literature review and expert consensus, with moderate to high quality evidence supporting the use of methotrexate as a glucocorticoid-sparing agent and the association of female sex, high erythrocyte sedimentation rate (ESR), and peripheral arthritis with a higher relapse risk 1.
Clinical Implications
In clinical practice, the choice of initial dose and tapering regimen should be guided by the individual patient's risk factors, comorbidities, and response to treatment, with regular monitoring of disease activity, laboratory markers, and adverse events 1.
The FDA Drug Labels for prednisone (PO) do not address this question.
From the Research
Typical Prednisone Dosage for Polymyalgia Rheumatica (PMR)
- The typical prednisone dosage for PMR is between 10-20 mg/day, with some studies suggesting a starting dose of 12.5 mg/day 2, 3, 4.
- A study found that 12.5 mg prednisone is a sufficient starting dose in 78.3% of PMR patients, with the main factor driving response to prednisone being weight 2.
- Another study suggested that an initial dose of prednisone of 10-20 mg/day yields clinical improvement in the majority of patients with PMR, generally achieved within 7 days of the onset of this therapy 3.
Tapering Regimen
- The tapering regimen for prednisone in PMR patients is not well established, but some studies suggest a slow tapering rate of less than 1 mg/mo to minimize relapses 5, 6.
- A study found that relapses of PMR are not uncommon when the dose of prednisone is equal to or below 5 mg/day, and that methotrexate can be used as a corticosteroid-sparing agent 3.
- Another study suggested that a maintenance dose of 7.5 mg prednisolone after 6-9 months should be enough for both PMR and GCA patients, and that steroid withdrawal is possible within 2 years of starting treatment 5.