- Design
- Systematic review and meta-analysis of 36 RCTs and 7 observational studies
- Population
- Patients with IBD on advanced therapies vs placebo or comparators
- Primary outcome
- Major adverse cardiovascular events
- Effect
- RCTs OR 0.60 (0.24–1.51); anti-TNF observational OR 0.29 (0.21–0.40)
A meta-analysis in Inflammation Research (14 September) pooled 43 studies — 36 randomised trials, including nine long-term extensions, and seven observational studies — on major adverse cardiovascular events (MACE) with advanced therapies in inflammatory bowel disease.
In placebo-controlled trials there was a non-significant trend towards fewer MACE (OR 0.60, 95% CI 0.24–1.51). By class, estimates were imprecise: IL-12/23 inhibitors 0.35 (0.05–2.21), JAK inhibitors 0.57 (0.16–2.06), anti-TNF 3.04 (0.31–29.5). Observational studies pointed the other way for some classes: anti-TNF was associated with lower risk (0.29, 0.21–0.40), and JAK inhibitors with a non-significant increase (1.57, 0.86–2.84).
Events in IBD trials are rare, so the trials cannot settle this. For JAK inhibitors, regulators already advise caution in patients over 65, smokers and those with cardiovascular risk factors, based on data from rheumatoid arthritis; nothing here overturns that.
- Assess cardiovascular risk before starting a JAK inhibitor
- Follow regulatory cautions for JAK inhibitors in older patients, smokers and those with cardiovascular risk
- Control inflammation — active IBD itself raises cardiovascular risk
- Manage blood pressure, lipids and smoking alongside IBD therapy
Why it matters
It tells gastroenterologists the IBD-specific data neither confirm nor dismiss cardiovascular concerns carried over from other diseases.
Don't overread it
The absence of a significant effect here reflects too few events, not proof of safety.
The statistics, in plain English
Every trial-based interval crosses 1, some very widely (0.31 to 29.5 for anti-TNF), because heart attacks and strokes are rare in young IBD trial populations. Observational estimates are more precise but open to confounding by who gets which drug.
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