Safety of Biologics and Janus Kinase Inhibitors in Inflammatory Bowel Disease Patients with Low Cardiovascular Risk

Summary A retrospective cohort study of 113,729 IBD patients with low cardiovascular (CV) risk using the US National TriNetX database. Anti-TNF and anti-integrin therapies were linked to reduced major adverse cardiovascular events (MACE), while JAK inhibitors showed no increased risk. Background Due to underlying chronic inflammation, inflammatory bowel disease (IBD) is associated with an increased risk of major adverse cardiovascular events (MACE). There is limited data on the role of cardiovascular (CV) risk factors and IBD medications on MACE. We aim to determine the association between MACE and IBD medications in a large national cohort of IBD patients with low baseline CV risk. Methods We conducted a retrospective cohort study between January 1, 2015—November 15, 2023 using the TriNetX database. Using logistic regression analysis, IBD patients exposed to biologics and small molecules were assessed for outcomes of individual and composite MACE [myocardial infarction (MI), ischemic stroke, percutaneous coronary intervention (PCI)/coronary artery bypass graft (CABG)]. Outcomes were adjusted for demographics, non-advanced IBD therapies, statin use, CV risk factors, and prior history of coronary artery disease (CAD). Results We identified 113,729 IBD patients with an average age of 42 years and low prevalence of CV risk factors (5-6%). Anti-TNF therapy was associated with a statistically significant decreased risk of composite MACE [adjusted OR (aOR) 0.795, 95% CI 0.670-0.930, p = 0.005] and PCI/CABG [aOR 0.56, 95% CI 0.274-0.562, p = 0.002] and anti-integrin therapy was associated with a decreased risk of composite MACE [aOR 0.76, 95% CI 0.580-0.980, p = 0.035]. Anti-IL12/23 and JAK inhibitors showed no increased risk of MACE. Conclusion In a cohort of young IBD patients with low CV risk, use of anti-TNF and anti-integrins is associated with a decreased risk of MACE and there was no increased risk of MACE with JAK inhibitors.