Unveiling a Novel Trend: Belimumab Amplifies Retinal Microvascular Density Decline in Lupus Nephritis Patients Revealed by Optical Coherence Tomography Angiography

Abstract

Background: In systemic lupus erythematosus (SLE), retinopathy is connected to severe disease and poorer prognosis. This study aimed to investigate changes in retinal vascular density (VD) in SLE and lupus nephritis (LN) patients and to examine the effects of Belimumab and hydroxychloroquine (HCQ) on retinal VD in these patients. Methods: This cross-sectional study enrolled 54 SLE patients (21 with LN and 33 without LN). A comprehensive ophthalmological evaluation using optical coherence tomography angiography (OCTA) was conducted on SLE patients. Rheumatological evaluations were performed through the collection of relevant clinical and laboratory data, as well as the assessment of rheumatological treatment. Results: We found that the mean VD in the superficial capillary plexus (SCP-VD) of most regions showed a significant decrease in the LN group. Further analysis revealed that LN patients using Belimumab exhibited a reduction in SCP-VD and deep capillary plexus VD (DCP-VD) (P<0.05). Furthermore, LN patients who had been using HCQ for more than 5 years exhibited a notable decrease in DCP-VD. Notably, SCP-VD and the cumulative dose of HCQ demonstrated a significant negative correlation. Conclusion: This study provides insights into the changes in retinal vascular density in LN patients and highlights the potential impact of long-term Belimumab and HCQ treatment on retinal microvascular damage. These findings contribute to the development of effective strategies for preventing and managing retinal complications in LN patients.