However, placebo-controlled trials (TULIP 1 and TULIP 2) failed to demonstrate benefit when conventional measures of lupus activity were used, and only marginally significant benefit when modified lupus scores were used. 53 , 54 Pregnancy Pregnancy can present challenges in women with lupus, so pregnancy planning and counselling are important. 55 Fertility rates are normal in lupus, unless compromised by cyclophosphamide 56 or worsening renal failure.
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