Unresponsive to prednisone?

I have noticed more than one case where platelets did not respond significantly to prednisone.
I have learned (see below) that other glucocorticoids may work when prednisone does not.
Has anyone here responded to a different glucocorticoid when prednisone did not work?

I am also curious whether other treatments can be ruled out if glucocorticoids are ineffective.
For example, has anyone responded to immunomodulating drugs like Rituxan after a non-response to glucocorticoids?
Or, does failure to respond to glucocorticoids indicate a need to abandon treating platelet destruction, and to begin treatment with TPO-RAs?

As discussed in the journal article below, prednisone only works after it has been converted by the liver into prednisolone. Some people do not produce the enzyme that converts prednisone into prednisolone, which is the active form, and as a result they do not respond to prednisone, but will respond to other glucocorticoids. This is an area where more research is warranted, but keep this in mind, that if prednisone does not raise your platelets, you might want to try other glucocorticoids.

www.jrheum.org/content/37/8/1559.full J Rheumatol 2010;37;1559-1561
Are There Patients with Inflammatory Disease Who Do Not Respond to Prednisone?

Hi Rob,
I was unresponsive to Prednisone ,Dexamethasone Ivig and Rituxan. Eltrombopag was an immediate success 4 years ago but as I've said before it is much less effective now , though with perseverance my count has gradually gone from 1 to 27 over 9 months on 75 mg daily . My consultant is happy for me to continue like this ,having a count every 8 weeks as at this level I have no symptoms .I even get to fly!

Yes, but I have no idea which one it was. Dougie didn't have much of a response at all to prednisolone (I think its the same thing but we have a different name) but he had a much better response to whatever was the steroid that they gave him at the same time as the rituximab. Whilst I wouldn't count it as a 100% success, one of those gave him a consistent count in the 30s for several months.

Interestingly, the acne drug (roaccutane) seems to have worked miracles for his platelets and his count has been much higher since he started it - although he's just come off it so I am waiting to see whether or not the effect lasts.

Romiplostim worked a treat for Dougie when he had two shots of it prior to minor surgery

Ali - prednisone & prednisolone are the same but different:

"Prednisone is activated by enzymes in the liver to turn into prednisolone. They do have similar uses but prednisolone is more readily absorbed by the body."

(don't have the source - had copied this a while back and forgot to add the source]

LOL, that's useful to know, I've always assumed they were the same thing! Why do you get the less effective one in the US......why do they not prescribe the best one that is more readily absorbed then?

My platelets started falling as soon as taper began on Prednisone, with Promacta have gone up significantly.

I had no true response from prednisone either. Started Rituxan and have had 2 of 4 infusions. I was told it would be awhile before I see results. Tapering off the prednisone.

Barb111,

You wrote elsewhere, "I really aren't having any side effects on it [prednisone] except for the increased BP. I sleep great, no increased appetite. No moon face. I actually lost 4 pounds!" That, in addition to prednisone not having any effect on your platelets, makes me wonder if you might be one of those people in the article above, who would respond to prednisolone but not prednisone.
www.jrheum.org/content/37/8/1559.full J Rheumatol 2010;37;1559-1561
Are There Patients with Inflammatory Disease Who Do Not Respond to Prednisone?

"Failure to observe the expected effects of prednisone therapy should bring to mind the fact that a very rare patient may lack the hepatic enzyme system that converts prednisone to prednisolone, its active metabolite"

Might there then be patients with inflammatory disorders who do not respond clinically as expected to prednisone but respond to prednisolone? We think so.

We suspect prednisone unresponsiveness when we do not observe the expected clinical response at reasonable doses of prednisone, when patients who initially responded to methylprednisolone relapse after being placed on prednisone, and when these patients do not manifest the anticipated physical and metabolic changes of corticosteroid administration (Cushingoid features, increase in appetite, weight gain, insomnia, leukocytosis, eosinopenia, and lymphopenia). We offer such patients a trial of methylprednisolone therapy when we consider steroid therapy most appropriate for their condition, before utilizing other antirheumatic, antiinflammatory, or so-called immunomodulatory/immunosuppressive (“second-line”) agents. (Note that this form of prednisone unresponsiveness is quite different from generalized glucocorticoid resistance, where patients are resistant to all forms of steroids, and from those with selective responsiveness to betamethasone​, and is beyond the scope of this discussion.)

I have looked and looked, and cannot find out whether this phenomenon applies to dexamethasone, so I cannot say whether it would work on you if you are unresponsive to prednisone.

You may want to print out the article and show it to your hematologist. It is really helpful to have a steroid to turn to if platelets drop too low.

Thanks for the info! I will definitely ask. Yes, it would be nice to have a first line treatment to go to.

Hi- I was completely unresponsive to both prednisone and dexamethasone. I did respond very briefly to
Ivig....had no response to 100 Mg promacta (and I weigh
55 kg). I respond very well to nplate though (9-10mcg/kg).

It would make sense if the same class/mechanism drugs worked or didn't- but at least with me it seems
Almost completely random.

I am on prednisone now for 3 months and have had no positive response at all. While taking pred, I have had IVIG and just finished up Retuxan with my platelets dropping to very low levels.

If you are not responding to Prednisolone why are you still on it?