Would you recommend adding a novel agent, such as lumasiran or nedosiran, to treat a newly diagnosed patient with primary hyperoxaluria type 1 who has preserved kidney function and persistent but significantly improved urinary oxalate levels following pyridoxine initiation?

I believe this is a fairly nuanced question. The answer really depends on the patient under question. Important considerations include how completely they responded to the pyridoxine, if there are any issues with them taking it regularly, and their current clinical course, including the number of stones and kidney function. There are also considerations regarding the patient and their preferences. Certainly, this would be an opportunity for shared decision-making.