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Topics:
Internal Medicine • Rheumatology • Reproductive Health • Systemic lupus erythematosus • Pregnancy • DMARD
What is your approach to transitioning an SLE patient from a pregnancy incompatible regimen to pregnancy compatible regimen?
For example, when switching from MMF to azathioprine, do you overlap the treatments as you lower the dose of one and add the other?
Answer from: at Academic Institution
There are no clear data on how to do this. One study (Fischer-Betz et al., PMID 23382355) transitioned patients by reducing the MMF by 500mg/d dosing every four weeks and then stopping MMFo once the patient is down to MMF 500mg/d and adding azathioprine 2mg/kg. In my clinical practice, I taper faste...
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Answer from: at Community Practice
I agree with Dr. @Bonnie Bermas and Dr. @Cuoghi Edens that there are not clear data, and it is more of an art than a science.
My rationale:
If I have someone preparing for pregnancy: that person has been in remission or close to remission for at least 3-6 months minimum (for the 3 months, it is be...
Answer from: at Academic Institution
This is definitely more of the art than the science of lupus management.
I tend to overlap, but work fairly quickly, with alternating lab work and dose escalations to titrate up the azathioprine (after TPMT is obtained) in this MMF->aza swap. I do try to have them wait for 3 months after stoppin...