S1799 Real-World Comparison of Cardiovascular Safety: Old vs New Biologics in Inflammatory Bowel Disease Over 5 Years

Introduction: Patients with inflammatory bowel disease (IBD) face an elevated risk of cardiovascular complications due to systemic inflammation and treatment side effects. Biologic therapies, including anti-TNF agents and newer agents targeting integrins or interleukin (IL)-12/23 pathways, are critical for managing moderate-to-severe IBD, but their comparative cardiovascular safety remains underexplored. Using real-world data, we evaluated the risks of myocardial infarction (MI), stroke, heart failure, and arrhythmias in patients treated with old vs new biologics over 5 years to provide insights into their safety profiles. Methods: We conducted a retrospective cohort analysis using the TriNetX global health research network, including adult IBD patients treated with biologics between 2015 and 2023. Patients with prior cardiovascular conditions were excluded. Propensity score matching balanced demographics, comorbidities, and disease severity (n = 22,009 each). Cardiovascular outcomes were identified using International Classification of Diseases-10 codes and assessed at 1, 3, and 5 years. Kaplan-Meier survival analysis, risk differences, risk ratios (RR), odds ratios (OR), and hazard ratios (HR) were calculated to compare groups. Results: MI and stroke risks were comparable between old and new biologics at all time points (P > 0.05). Heart failure risk was consistently lower in the new biologics group at 1, 3, and 5 years, with heart failure-free probabilities of 99.94%, 99.82%, and 99.77%, respectively, compared to 99.88%, 99.73%, and 99.62% for old biologics (P < 0.05 for all time points). Arrhythmia risk was significantly reduced at 1 year (P = 0.003) but showed no significant difference at 3 years (P = 0.076) or 5 years (P = 0.114). Conclusion: Our study demonstrates that newer biologics significantly lower cardiovascular risks, particularly heart failure, compared to older biologics in IBD management. The reduced risk of arrhythmias at 1 year highlights their potential for short-term cardiovascular benefits. By leveraging real-world data, we provide a comprehensive evaluation of cardiovascular safety that reflects everyday clinical practice. These findings emphasize the critical role of cardiovascular safety in biologic selection, improving long-term outcomes especially for high-risk IBD patients. Future prospective studies should validate these findings across diverse populations and explore mechanisms driving the observed benefits of newer biologics.