PO:18:268 | Voclosporin as a Steroid-Sparing Agent in Lupus Nephritis Complicated by Central Serous Chorioretinopathy: A Case Report

Irene Genovali^1|2, Sebastiano Lorusso², Damiano Currado^1|2, Letizia Pia Di Corcia¹, Ludovica Lamberti¹, Annalisa Marino², Antonio Orlando¹, Maria Quadrini¹, Marta Vadacca², Marta Vomero¹, Luca Navarini^1|2, Roberto Giacomelli^1|2 | ¹Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Biomedico, School of Medicine Rome, Italy; ²Clinical and Research Section of Rheumatology and Clinical Immunology Fondazione Policlinico Campus Biomedico Rome, Italy

Objective. To evaluate the efficacy and safety of voclosporin as a steroid-sparing agent in the treatment of Lupus Nephritis complicated by corticosteroid-induced central serous chorioretinopathy.

Materials and Methods. A 51-year-old woman with no prior medical history presented in March 2023 with nodular, non-pruritic facial lesions and arthralgias. In April 2023, a skin biopsy was performed, revealing findings consistent with Systemic Lupus Eritemathosus. In October 2023, she was referred to our rheumatology clinic for worsening diffuse arthromyalgias with 2 swollen joints and morning stiffness, fatigue, weight loss, and fever. At the time of evaluation, she was receiving prednisone 12.5 mg daily. Laboratory investigations revealed markedly elevated inflammatory markers, an ANA titre of 1:5120 (homogeneous pattern), and strongly positive anti-dsDNA, anti-Sm and anti-RNP antibodies. Urinalysis demonstrated albuminuria, pyuria and haematuria. A complete blood count showed mild anaemia and lymphopenia, with normal platelet levels. Due to suboptimal blood pressure control and a progressive increase in 24-hour proteinuria (504 mg/24h), a renal biopsy was performed. Histopathological examination revealed diffuse Lupus Nephritis, classified as class V in association with class III (A/C), according to the ISN/RPS classification. Following the biopsy, the patient received three intravenous pulses of methylprednisolone (1000 mg each), and oral mycophenolate mofetil was initiated at a dose of 2 g/day. Given the aggressive disease course and declining renal function, treatment with a calcineurin inhibitor (voclosporin, 23.7 mg twice daily) in combination with mycophenolate was commenced in February 2024, with a baseline eGFR of 43.4 mL/min and serum creatinine of 1.4 mg/dL. Shortly thereafter, the patient developed central serous chorioretinopathy, prompting ophthalmologic consultation and the recommendation to taper corticosteroids rapidly.

Results. Prednisone was progressively reduced to 2.5 mg daily in three months and fully discontinued by January 2025. At that time, her SLEDAI-2K score had decreased to 0, in therapy with voclosporin 23.7 mg twice daily, hydroxycloroquine 400 mg daily and mycophenolate mofetil. Following the initiation of voclosporin, normalization of proteinuria was observed, despite the rapid tapering of the steroid, along with a transient increase in serum creatinine (1.5 mg/dL) and a reduction in eGFR to 39.9 mL/min. Over the subsequent months, renal function progressively improved. At the most recent follow-up in February 2025, one year after initiating voclosporin, serum creatinine was 1.31 mg/dL and eGFR had increased to 47.0 mL/min.

Conclusions. Voclosporin proved to be an effective steroid-sparing agent in a patient affected by severe Lupus Nephritis complicated by corticosteroid-induced central serous chorioretinopathy. It allowed rapid tapering and discontinuation of corticosteroids with sustained renal disease control and clinical remission, without long-term impairment of renal function. This treatment strategy represents a promising alternative to minimize steroid-related adverse effects in Lupus Nephritis patients.