S1803 Comparative Impact of Biologic vs Non-Biologic Therapy on Arrhythmia Risk in Inflammatory Bowel Disease: A 5-Year Propensity-Matched Study

Introduction: Chronic systemic inflammation in inflammatory bowel disease (IBD) has been implicated in cardiovascular complications, including arrhythmias, yet limited data exist on whether therapy choice modifies this risk. Biologic therapy, through inflammation control, may offer protective cardiac effects. This study evaluates the comparative risk of arrhythmia in IBD patients treated with biologic vs non-biologic therapy over 1, 3, and 5 years. Methods: We analyzed electronic health records from 225,303 adult IBD patients in the TriNetX Research Network. Patients with prior arrhythmias, myocardial infarction, stroke, or heart failure were excluded. Cohorts receiving biologic or non-biologic therapy were propensity score matched for demographics, comorbidities, and disease severity, yielding balanced groups at 1 year (N = 16,179), 3 years (N = 16,181), and 5 years (N = 15,821). Arrhythmia incidence was the primary outcome. We performed Kaplan-Meier survival analysis and calculated risk ratios (RRs), hazard ratios (HRs), and P-values. Results: Non-biologic therapy was associated with consistently higher arrhythmia rates. At 1 year, arrhythmia incidence was 0.66% vs 0.19% (RR = 3.6, 95% CI: 2.38-5.34), with arrhythmia-free survival of 99.12% vs 99.75% (P < 0.0001, HR = 3.57, 95% CI: 2.38-5.34). At 3 years, risk rose further (1.14% vs 0.23%; RR = 4.8, 95% CI: 3.42-6.87), with survival of 98.08% vs 99.64% (P < 0.0001, HR = 4.7, 95% CI: 3.32-6.67). At 5 years, non-biologic therapy had a 1.21% incidence vs 0.30% (RR = 4.1, 95% CI: 2.96-5.59), with survival of 97.50% vs 99.38% (P < 0.0001, HR = 3.84, 95% CI: 2.79-5.23). Mean recurrence scores were also significantly higher in the non-biologic group at 1 year (t = -2.51, P = 0.013) and 5 years (t = -2.94, P = 0.004). Conclusion: Biologic therapy is associated with significantly lower arrhythmia risk across all time points in IBD patients. These findings support the role of biologics not only in controlling gut inflammation but also in alleviating cardiovascular risk. Incorporating arrhythmia prevention into therapeutic decisions may improve long-term outcomes. While propensity score matching reduces confounding, prospective studies are needed to confirm these cardioprotective effects.