Where do novel small molecules fit in the IBD treatment pathway for women of childbearing age?

Decision-making for advanced therapies in women of childbearing age requires a joint-up approach that considers family planning status and the reproductive safety of the available choices. Clinicians should not make any assumptions regarding patient plans. While biologic therapies for inflammatory bowel disease are generally considered low risk for any planned or unplanned pregnancy, small molecule drugs (SMD), including Janus kinase inhibitors and sphingosine-1-phosphate modulators, are associated with adverse events in animal models and very limited human data so far. The current lack of reproductive safety needs to be considered. It is not acceptable to exclude women of childbearing age from SMD therapy, but equally, SMD treatment should not be prescribed without appropriate counselling. SMD choices should be discussed as part of shared decision-making with well-informed patients. In this review article, we summarise the current evidence and provide clinicians with advice regarding therapy choices.