Ab1183 the Use of Mycophenolate Mofetil in Limited Cutaneous Systemic Sclerosis Is Associated With a Reduced Risk of Vascular Complications Requiring Pharmacological Intervention Upgrades

Background: The prescription of Mycophenolate Mofetil (MMF) represents the main treatment for interstitial lung disease (ILD) associated with SSc and an option for cutaneous fibrosis, but its use in patients with Limited Cutaneous Systemic Sclerosis (lcSSc) is less common due to their lower fibrotic burden. In vitro observations and clinical data from kidney transplant patients suggest a protective effect of MMF on endothelial function. Objectives: The study objective is to explore the impact of MMF therapy in preventing the escalation of vasoactive/vasodilator treatment as a surrogate for vascular complications of the disease. Methods: Clinical data of patients with lcSSc enrolled in the Italian SPRING registry were retrospectively compared based on the prescription of MMF at any stage of their disease. Each patient treated with MMF for at least 3 months were matched to another not treated and evaluated in the same quarter using a time-dependent propensity score based on age, gender, disease duration, presence of anti-centromere antibodies (ACA)+, anti-Scl-70+, lung fibrosis, pulmonary function tests, history of digital ulcers, and treatment with iloprost, calcium channel blockers, endothelin receptor antagonists (ERA), and phosphodiesterase-5 inhibitors (PDE5i). The escalation of vasoactive/vasodilator treatment over up to 60 months was assessed as the addition of iloprost, ERA, or PDE5i due to uncontrolled or newly diagnosed peripheral vascular manifestations or pulmonary arterial hypertension. Results: Clinical characteristics of the evaluated 1425 patients are reported in Table 1. The prescription of MMF was more common in male patients, anti-Scl70 positive, anti-centromere negative, with a history of interstitial lung disease or myositis, and without a history of ulcers. The patients selected after matching for longitudinal evaluation were assessed for a median time of months. The overall incidence of vasoactive/vasodilator treatment escalation events over a median 57.0 (IQR 25.0-60.0) follow-up was 1.0 per 100 patient-years in the MMF-treated group and 7.3 per 100 patient-years in the control group, with a significant difference in treatment escalation-free survival between the two groups (Log-Rank test p<0.001) (Figure 1). Conclusion: In the national SPRING cohort, the decision to prescribe MMF is primarily driven by the presence of risk factors for progressive pulmonary manifestations and a history of myositis. The association of MMF therapy with a reduced need for escalation of vasoactive or vasodilator treatment suggests a potential impact of this drug in preventing vascular complications in patients with lcSSc. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.