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Introduction The prescription of Mycophenolate Mofetil (MMF) represents the primary treatment for interstitial lung disease (ILD) associated with systemic sclerosis (SSc) and is an option for cutaneous fibrosis. However, its use in patients with Limited Cutaneous SSc (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. The objective of this study is to explore the impact of MMF in preventing escalation of vasoactive/vasodilator treatment as a surrogate for vascular complications.Material and Methods Clinical data of lcSSc patients in the Italian SPRING registry were retrospectively compared based on MMF use at any stage of their disease. Patients treated with MMF for at least 3 months was then matched to another patient not treated with MMF and evaluated in the same quarter using a time-dependent propensity score. The score was based on age, gender, disease duration, presence of anti-centromere antibodies and anti-Scl-70+ antibody, ILD, pulmonary function tests, history of digital ulcers, and baseline treatment with iloprost, calcium channel blockers, endothelin receptor antagonists (ERA), and phosphodiesterase-5 inhibitors (PDE5i). Standardized mean differences (SMDs) after matching were reported as a measure of balance between the intervention and comparison group, with values < - 0.1 indicating good balance. The outcome was escalation of vasoactive/vasodilator therapy (addition of iloprost, ERA, or PDE5i) for uncontrolled or new peripheral vascular complications over 60 months.Results Clinical characteristics of the evaluated 1,435 patients are reported in table 1. The prescription of MMF was more common in male patients, those who were anti-Scl70 positive and anti-centromere negative, those with a history of interstitial lung disease or myositis, and those without a history of ulcers. Matching led to SMD<0.1 for all the collected variables (data not shown). The overall incidence of vasoactive/vasodilator treatment escalation events over a median follow-up of 40.5 months (IQR 23.3-60.0) 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 = 0.002) (figure 1).Conclusions In the national SPRING cohort, the decision to prescribe MMF is primarily driven by the presence of risk factors for progressivE pulmonary manifestations. 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.Abstract P.204 Table 1Comparison of clinical variables between patients with IcSSc who were and were not prescribed MMF at the 4 last available follow-upAbstract P.204 Figure 1Comparison of cumulative incidence curves of vasoactive or vasodilator treatment escalation in MMF-treated patients and matched controls