S1802 Long-Term Risk of Stroke in Inflammatory Bowel Disease Patients: A Comparative Study of Biologic vs Non-Biologic Therapy

Introduction: Inflammatory bowel disease (IBD) is associated with systemic inflammation, increasing stroke risk via elevated cytokines, endothelial dysfunction, and hypercoagulability. Biologic therapy may reduce this risk by effectively controlling inflammation, yet comparative data on stroke outcomes in biologic vs non-biologic IBD therapies remain limited. This study aimed to assess whether biologic therapy reduces stroke risk compared to non-biologic therapy over 1, 3, and 5 years. Methods: Using the TriNetX Research Network, we analyzed electronic medical records from 225,303 patients across 94 healthcare organizations. Adults (≥18 years) with Crohn’s disease or ulcerative colitis were included, excluding those with prior stroke, myocardial infarction, heart failure, or significant arrhythmias. Patients were stratified into biologic vs non-biologic cohorts and propensity score-matched on demographics, comorbidities, and disease severity. Final matched cohorts included N = 16,179 (1-year), N = 16,181 (3-year), and N = 15,821 (5-year). The primary outcome was stroke incidence. Kaplan-Meier survival estimates and hazard ratios (HRs) with 95% confidence intervals were also reported. Results: Over the 5-year period, the non-biologic cohort demonstrated progressively worsening stroke outcomes. At 1 year, stroke incidence was 0.11% (18 cases) in non-biologic vs 0.06% (10 cases) in biologic patients (RR = 1.8, 95% CI: 0.83-3.9); while not statistically significant, Kaplan-Meier curves showed significantly lower stroke-free survival in non-biologic patients (99.86% vs 99.96%; P = 0.007; HR = 3.6, 95% CI: 1.34-9.73). At 3 years, stroke incidence was 0.10% (16 cases) vs 0.06% (10 cases) (RR = 1.6, 95% CI: 0.73-3.5) with continued survival disadvantage (99.83% vs 99.94%; P = 0.04; HR = 2.6, 95% CI: 1.006-6.574). By 5 years, the non-biologic group had triple the stroke incidence 0.18% (29 cases) vs 0.06% (10 cases) (RR = 2.9, 95% CI: 1.41-5.95), with significantly poorer stroke-free survival (99.63% vs 99.90%; P = 0.0005; HR = 3.9, 95% CI: 1.72-8.94). Conclusion: Biologic therapy is associated with significantly reduced long-term stroke risk in IBD patients. The effect grows over time, with marked differences emerging at 5 years. These findings highlight the potential of biologics to reduce stroke risk in IBD by controlling systemic inflammation. Prospective studies are needed to confirm causality and clarify underlying mechanisms with regard to the progressive temporal divergence in the statistical significance observed.