S1800 Newer Biologics Associated With Reduced Hospitalization Compared to TNF Inhibitors in Inflammatory Bowel Disease: A 5-Year Real-World Analysis

Introduction: IBD affects millions of Americans and imposes substantial healthcare costs due to hospitalizations, a key marker of disease control. This study compares hospitalization rates between TNF inhibitors and newer biologics over 1, 3, and 5 years. Methods: Using TriNetX, we conducted a retrospective cohort study of IBD patients ≥18 years who initiated TNF inhibitors or newer biologics (January 2015–December 2020). Propensity score matching balanced demographic and clinical characteristics (n = 20,354 per group). Hospitalization-free probabilities were assessed using Kaplan-Meier analysis, with hazard ratios (HR) and 95% confidence intervals (CI) calculated for comparative risk over time. Results: Newer biologics consistently demonstrated lower hospitalization rates across all time points. At 1 year, the hospitalization rate was 8.1% for newer biologics vs 11.1% for TNF inhibitors (P < 0.001; OR 1.414; 95% CI [1.328–1.508]). This trend persisted at 3 years (11.3% vs 13.9%; P < 0.001; OR 1.263; 95% CI [1.209–1.349]) and 5 years (12.5% vs 14.8%; P < 0.001; OR 1.219; 95% CI [1.175–1.305]). Kaplan-Meier analysis demonstrated consistently higher hospitalization-free probabilities for newer biologics, with significant differences observed at 1 year (90.76% vs 87.87%), 3 years (84.47% vs 82.28%), and 5 years (79.39% vs 78.07%; P < 0.001 for all time points). Conclusion: Newer biologics significantly reduced hospitalization rates compared to TNF inhibitors, with differences observed as early as 1 year and sustained through 5 years. These findings highlight the potential for newer biologics to improve disease control and reduce healthcare costs in IBD management. Future research should investigate whether these reductions stem from improved disease control or fewer treatment-related adverse events.