Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London, spoke on issues regarding the current standard of care for lupus nephritis, including steroid overuse, pregnancy, and dose-related toxicity.
There is an overuse of steroids in the current standard of care for lupus nephritis, as well as pregnacy and fertility concerns that female patients, often of childbearing age, should be aware of, said Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London.
Transcript
Can you speak on any issues regarding the current standard of care for lupus nephritis?
So, the current standard of care would either be a combination of steroids with mycophenolate mofetil or steroids with low-dose cyclophosphamide. They're both pretty effective. A few patients never tolerate mycophenolate—they feel nauseated, they feel horrible—but it's usually well tolerated. It damages fetuses, so it's teratogenic. So, it's a real problem.
This is a disease that affects women of childbearing age. They shouldn't get pregnant when they've got active lupus nephritis anyway, but you have to tell them that even when we've got them into remission, they've got to wait, they've got to change to a new drug, usually azathioprine, and wait and see that they're okay on that and then they can change.
Cyclophosphamide is also teratogenic, but also can affect fertility. With the doses we usually use it, not so much and we use ovarian protection to reduce that. But that's an intravenous preparation, it can make people feel a bit sick. It is very effective, but it has a dose-related toxicity so you can't use it repeatedly. You can do a cycle. If they go into remission, fine, then they’re going to go on to [mycophenolate mofetil] for maintenance.
So, there's a real issue around pregnancy and fertility. Patients just don't like taking tablets, and in aiming to minimize steroids, a lot of the current regimens still have a lot of steroids in. The KDIGO [Kidney Disease Improving Global Outcomes] guideline from last year said, if they're in remission for a year, wean them off completely. I would argue you could wean them off much sooner than that. But there's still far too much steroid in the current regimens.
Bridging the Gaps: New Strategies for Preventing Cardiovascular Disease
July 31st 2025During the Addressing Cardiovascular Risk and Intervening Early webinar, experts discussed innovative strategies for cardiovascular disease prevention, emphasizing risk assessment, lifestyle changes, and collaborative care to improve patient outcomes.
Read More
Taletrectinib Recommended in NCCN Guidelines for ROS1-Positive NSCLC
July 31st 2025Taletrectinib was added to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology as a preferred option for the first-line and subsequent treatment of advanced ROS1-positive non–small cell lung cancer (NSCLC).
Read More
Trends in Insulin Out-of-Pocket Costs and Use Disparities, 2008-2021
July 31st 2025Given trends in cost and use, insulin out-of-pocket cost reduction policies would be more efficient if they targeted members in high-deductible health plans with savings options and low-income patients.
Read More
Linvoseltamab Added as Preferred Agent in Newest MM Practice Guidelines
July 31st 2025On July 2, linvoseltamab-gcpt (Lynozyfic; Regeneron) received an accelerated approval from the FDA in relapsed/refractory multiple myeloma (MM), and the most recent update to the National Comprehensive Cancer Network guidelines for MM has added the BCMA-targeted bispecific antibody as a preferred treatment option.
Read More