Systemic Lupus Erythematosus Women with Lupus Nephritis in Pregnancy Therapeutic Challenge (SWITCH): The Systemic Lupus International Collaborating Clinics experience

One-third of women with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), and most receive mycophenolate mofetil (MMF), which is teratogenic and needs to be switched to a pregnancy-compatible drug before conception.1 2 Azathioprine (AZA) is the immunosuppressive of choice in SLE pregnancies, but best practice guidelines in rheumatology provide recommendations on neither pharmacogenetic testing (for thiopurine methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15) genes) nor therapeutic drug monitoring,2 3 likely due to lack of data in rheumatic diseases and limited indirect evidence in other populations (eg, inflammatory bowel disease). Recent evidence in a small number of patients suggests that AZA metabolite monitoring in women with SLE during preconception and/or gestation might provide key opportunities to personalise therapy during this critical time (eg, identification of ‘shunting’, non-adherence, subtherapeutic/supratherapeutic dosing).4 Therefore, we aimed to evaluate practice patterns pertaining to management...

Source: Annals of the Rheumatic Diseases - October 12, 2023 Category: Rheumatology Authors: Lee, J.-Y. E., Mendel, A., Askanase, A., Bae, S.-C., Buyon, J. P., Clarke, A. E., Costedoat-Chalumeau, N., Fortin, P. R., Gladman, D. D., Ramsey-Goldman, R., Hanly, J. G., Inanc, M., Isenberg, D. A., Mak, A., Mosca, M., Petri, M., Rahman, A., Sanchez-Guer Tags: ARD Letter Source Type: research