Comparing the risk of heart failure in patients with inflammatory bowel disease treated with infliximab versus adalimumab: a retrospective cohort study using a national database

Background Anti–tumor necrosis factor (TNF) agents are widely used for inflammatory bowel disease and have well-documented heart failure risk, but comparative cardiac safety remains uncertain.Methods We conducted a retrospective cohort study using the TriNetX US national database. Adults with Crohn’s disease or ulcerative colitis initiating infliximab or adalimumab were included. Patients with prior heart failure were excluded. The primary outcome was heart failure occurring ≥ 6 months after anti-TNF initiation. Propensity score matching was performed to balance baseline covariates.Results Before matching, 25,582 patients received infliximab and 24,301 received adalimumab. After matching, 21,554 remained in each group. Median follow-up was ≈ 3.65 years (infliximab) and ≈ 3.91 years (adalimumab). Heart failure occurred in 466 (2.21%) infliximab patients vs 383 (1.81%) adalimumab patients (risk ratio, 1.22; 95% confidence interval [CI] 1.068–1.395; P = 0.003). In an exploratory Cox model, infliximab was associated with a higher heart failure hazard, 1.179 (95% CI 1.029–1.35), and a significant Kaplan-Meier curve by log-rank test (P = 0.02).Conclusions In this national database analysis of patients with inflammatory bowel disease, infliximab was associated with a higher observed risk of incident heart failure compared with adalimumab.