Posted 7/6/2021 12:05 AM (GMT -6)
6mp dosing is usually 1.0 to 1.5 mg/kg of body mass. 187 lbs = 85kg, so your dosing would be 75mg or 100mg on the low side, most likely 125mg, and possibly 150mg on the high side. The 50mg you had been on probably hadn't been doing anything - it's too low.
As for pred, yes, 60mg is a high dose, but not unusually so. There's not much difference to a patient between 60 and 40 - side effects and effectiveness of the drug are pretty similar at those two doses. If 40mg works for you, there's no need to start at 60mg. 60mg is only better than 40mg for a small % of patients. For most people, it's not much if any more effective.
Whether to take pred or not is always a tough call. But you're clearly flaring, and pred should help that while the 6mp at higher dose is given time to work (because it's not gonna work immediately - it can take weeks or even months to kick in).
If you find you can't tolerate the higher 6mp dosing, you should jump to biologics.