S1806 Real-World Data Reveals Reduced Heart Failure Risk With New Biologics Compared to Old Biologics in Inflammatory Bowel Disease: A 5-Year Comparative Study

Introduction: Heart failure (HF) is a serious cardiovascular complication in inflammatory bowel disease (IBD), driven by systemic inflammation and potential treatment side effects. While older biologics such as anti-TNF agents have been the cornerstone of therapy, newer biologics targeting integrins or interleukin (IL)-12/23 pathways offer novel mechanisms of action that may further reduce systemic inflammation and cardiovascular risks. Leveraging real-world data, this study evaluates the risk of HF in IBD patients treated with old vs new biologics over 5 years, providing practical insights into their long-term safety. Methods: We analyzed real-world data from the TriNetX research network, focusing on adult IBD patients treated with biologics between 2015–2023. Patients with prior cardiovascular conditions were excluded. Propensity score matching balanced demographics, comorbidities, and disease severity between cohorts (n = 22,009 each). The cohort balance was validated through propensity score distributions before and after matching. HF risk and survival probabilities were assessed at 1, 3, and 5 years using Kaplan-Meier survival analysis, risk differences, risk ratios (RR), odds ratios (OR), and hazard ratios (HR) to compare groups. Results: New biologics consistently outperformed old biologics in reducing HF risk. At 1 year, HF risk was significantly lower in the new biologics group (HR: 2.11, 95% CI: 1.029–4.329, P = 0.04), a benefit sustained at 3 years (HR: 1.669, 95% CI: 1.015–2.745, P = 0.049) and 5 years (HR: 1.678, 95% CI: 1.049–2.685, P = 0.036). Kaplan-Meier analysis revealed higher HF-free survival probabilities for new biologics at all time points: 99.94% vs 99.88% at 1 year, 99.82% vs 99.73% at 3 years, and 99.77% vs 99.62% at 5 years (P < 0.05) for all comparisons. Conclusion: Our analysis demonstrates that new biologics substantially reduce HF risk in IBD patients compared to older biologics, with consistent improvements in HF-free survival over 5 years. This study provides valuable insights into the cardiovascular safety of newer therapies and emphasizes the importance of integrating cardiovascular risk assessment into treatment decisions. These findings have direct implications for future clinical guidelines, particularly in optimizing biologic therapy selection for IBD patients at high cardiovascular risk. Future research should validate these results in diverse populations and further explore the mechanisms driving these cardiovascular benefits.