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Mycophenolate safety — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyMycophenolate safetySCE Rheumatology

A 30-year-old woman with lupus nephritis is stable on mycophenolate mofetil. She has a positive pregnancy test at 6 weeks' gestation after contraceptive failure. Creatinine is normal and proteinuria is stable. She is distressed and asks what to do next. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stop mycophenolate and urgently involve obstetric medicine/rheumatology

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

Stop mycophenolate and urgently involve obstetric medicine/rheumatology is best because mycophenolate is teratogenic and should be stopped with urgent specialist pregnancy counselling and disease-control planning. A is less suitable because hydroxychloroquine is generally pregnancy-compatible and often continued; B is less suitable because dose escalation worsens exposure; D is less suitable because methotrexate is also teratogenic; E is less suitable because continuing exposure increases fetal risk. Clinical pearl: unplanned pregnancy on teratogenic immunosuppression needs urgent coordinated care, not routine follow-up.

Reference: BSR pregnancy and breastfeeding guideline 2022; BNF