Is there a correllation between pred tapering and a flare ?

[Alysia]

I got the impression, from reading posts here, that tapering pred can lead to a flare.
It is really so ?
how many around succeed in tapering pred without collapsing to a flare ?
How many flared soon after pred tapering ?

[Pete]

Might be interesting to conduct a regression analysis to see if there's a statistical relationship between lowest pred dosage and flare symptom onset. My data point would be a dose of zero and symptom onset at three months after reaching minimum dose.

However, just because there might be a statistical relationship, there might not be a causal relationship between these two variables.

[Dirty Don]

Went one month off pred, then flared. Did the lack of pred cause that...NO...the WG did...altho withdrawal is possible (have experienced that too) and feels bad for a bit, this is the lack of a needed (only) drug that controls the inflammation...thus, flare!!!

[annekat]

I flared eventually when I switched from CTX to MTX and the doc put me on too low a dose of the MTX, or that is my hypothesis. I was gradually tapering pred at the same time, from 15mg. down to 10mg. It took a few months for the flare to develop and be confirmed in my bloods. I should have had bloods earlier when it probably started, but the doc thought I was fine and it wasn't necessary. True, I wasn't all that sick yet, and had had a cold, so it was hard to tell the flare from getting over the cold. When it was clear I was flaring, my MTX was increased from 10mg. to 15mg., a more therapeutic amount, and the pred was put back up to 20mg. The flare was knocked out over the next couple months and I tapered back down to 10mg. pred but stayed on the 15mg. MTX. So it is hard to say what contributed most to stimulating the flare... the low MTX dose, the cold, or tapering the pred... in this case, I think it was the first two more than the pred taper.

So, anyway, Don is of course right that it is the WG that causes the flare, and it is simply what can happen when we start taking away the drugs that keep it under control, unless we are in a drug-free remission. As long as we are on the meds, it seems to me that we may flare if we try to reduce dosages or stop, whether it be pred or the immunosuppressant we are on. The Wegs dog is still napping in our bodies and can be woken up by a taper of pred or other change in meds. So in that sense, a pred taper may lead to a flare, even if it isn't the direct cause, since if we didn't taper, the Wegs dog might not have noticed anything different and might have stayed asleep. And of course it doesn't mean that everyone who tapers too fast will flare. We may get some increased symptoms during tapering, since after all we are not in a med-free remission, but these may subside and not constitute a real flare. That is my take on it, anyway, and I don't mind being corrected if I'm wrong.

[Geoff]

In my minds eye, pred is there to put out the fire when you flare and also of course when you start your road to remission just to start you off right. Sadly in the 5 years since DX I have never managed to get below 5mg, and when I try I feel dog rough.
Of course this might be down to my adrenal glands which may have switched off after such a prolonged time of pred use. I hope to get the answers in 2 weeks time when I have a synapthem (Sp?) test.
Apart from blown adrenal glands I think if you flare when you taper then either your maintenance drug is not sufficient for your needs, or perhaps you have tapered too fast?

[Alysia]

I think if you flare when you taper then either your maintenance drug is not sufficient for your needs, or perhaps you have tapered too fast?

thanks Geoff and everyone around
for now, this is only a "theoretical question".
I hope I will not have to consider it in reality.
I am trying to get down from 5mg to 4 mg. lately a bit with less symptoms but still very "shaky".

[gilders]

Hi Alysia,
This is how my flares/relapses have occurred in correlation with pred -
1st relapse happened within 1 week of coming completely off pred
2nd relapse happened within 1 month of coming completely off pred
3rd relapse happened within 3 months of coming completely off pred
4th relapse happened within 6 months of coming completely off pred

This was over a period of approximately 13 years with each relapse being quite aggressive, causing more damage to my kidneys each time, BUT responding quite well to AZA and Pred treatment (i.e. no need for chemo like initial onset of the disease).

My 5th relapse which only got diagnosed by biopsy a few weeks ago (but I think it started just over 12 months ago) has been different.
Firstly I managed a massive 3-4 years off pred.
Secondly this flare has so far left my kidneys alone and has been a slow "burning" flare.
Thirdly although this flare is MUCH less aggressive than my other flares, strangely it does seem to be responding to my usual fairly basic treatment of Aza and pred.

I am hopeful that the trend continues, i.e. I manage to go longer off pred each time between flares, but it has been mentioned that one more flare would likely lead to being on pred for life.


The dates/time periods are correct to my knowledge, but after 19 years of dealing with WG it's hard to remember precisely, but I'm certain they're at least VERY close to the exact time periods.