ArticleTherapeutic advances in gastroenterology2024
Appropriateness of small molecule agents for patients with IBD of childbearing age - a RAND/UCLA appropriateness panel.
Article in Therapeutic advances in gastroenterology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Upadacitinib as rescue therapy for acute severe ulcerative colitis and severe Crohn's disease - current knowledge and future directions.Pharmacological reports : PR · 2026Review
- Drug-associated inflammatory bowel disease: a real-world pharmacovigilance study using the FAERS and JADER databases.Frontiers in immunology · 2026Article
- The Impact of Disease Activity and Medications on Pregnancy and Fetal Outcomes in Women With Inflammatory Bowel Disease: A Cohort Study From the IBD-ME Group.Journal of gastroenterology and hepatology · 2026Article
- Perspective: Making Treatment Decisions for Crohn's Disease in 2025-Key Considerations.Journal of clinical medicine · 2025Article
- Article
- Sphingosine-1-phosphate receptor modulators in ulcerative colitis - a narrative review of current evidence and practical considerations.Drugs in context · 2025Review
- Pregnancy and Preconception Care for Patients with Inflammatory Bowel Disease.Inflammatory intestinal diseasesReview
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Many women of childbearing age with inflammatory bowel disease (IBD) require advanced therapies. While biologics are largely low risk during pregnancy, the novel small molecules tofacitinib, filgotinib, upadacitinib and ozanimod (TFUO) have shown concerning teratogenic effects, and decreased fertility in animal studies. Therefore, their use in women of childbearing age needs careful consideration. Design: RAND/University of California Los Angeles (UCLA) Appropriateness Method (RAM). Objective: To evaluate the appropriateness of TFUO in women of childbearing age. Methods: We convened a panel of six gastroenterologists, two IBD nurses, one IBD pharmacist and three expert patients. Following a literature review, 13 statements were drafted and voted upon in 2 rounds. Results: All 13 statements were deemed appropriate. The panel concluded that women with IBD of childbearing age who wish to commence therapy with TFUO, need to use effective contraception and be counselled regarding the risk in unplanned pregnancies. For women using contraception while on Janus kinase inhibitor (JAKi) therapy, we suggest the preferred use of progesterone-only or non-hormonal long-acting contraception. TFUO are contraindicated during pregnancy and breast feeding. We recommend that women receiving TFUO cease therapy in time to establish clinical remission for at least 3 months prior to conception. Therapies other than TFUO should be considered as first-line therapy in women with IBD of childbearing age, except in select individual circumstances. TFUO may be appropriate for women of childbearing age after failure of, intolerance or contraindications to one biological agent. Conclusion: TFUO should be avoided during pregnancy and breastfeeding, and alternative therapies should be considered as first-line treatments. Summary: We provide clinical practice recommendations regarding the use of TFUO for IBD in women of childbearing age.
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