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Managing Risks with Newer Oral Small Molecules in Patients with Inflammatory Bowel Diseases

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Abstract

Purpose of Review

Treatment of Inflammatory Bowel Diseases (IBD) is challenging; thus, the need for newer therapeutic options with an oral route of administration has led to the development of novel small molecules drugs (SMDs). We aim to highlight the most common Adverse events (AEs) associated with SMDs and recommendations on monitoring for AEs before and during treatment.

Recent Findings

SMDs, such as Tofacitinib, a JAK inhibitor, have been associated with laboratory abnormalities, infections, and risk of thromboembolic events. Therefore, oral agents with greater selectivity in JAK inhibition, such as tofacitinib and upadacitinib, were later developed. Ozanimod and etrasimod, S1PR agonists, require closer safety profile monitoring by clinicians.

Summary

Multiple therapies have been recently developed with variable efficacy. However, they have been associated with AEs, and some require close monitoring prior to and during therapy. Clinicians should highlight these adverse events to patients while reassuring the safety profile of these novel SMDs for IBD is favorable.

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Data Availability

No datasets were generated or analysed during the current study.

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Funding

PD is supported by a Junior Faculty Development Award from the American College of Gastroenterology.

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Authors and Affiliations

  1. Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Malek Ayoub & Shivani Mattay

  2. Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Inflammatory Bowel Disease Institute, Los Angeles, CA, USA

    Andres J. Yarur

  3. Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus, Box 8124, St. Louis, MO, 63110, USA

    Parakkal Deepak

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Contributions

Malek Ayoub: Concept, Initial draft and approval of final draft. Shivani Mattay: Initial draft and approval of final draft. Andres J. Yarur: Editing draft for critical edits and approval of final draft. Parakkal Deepak: Concept, Initial Draft, Editing draft for critical edits and approval of final draft and guarantor of the article.

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Correspondence to Parakkal Deepak.

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Conflict of Interest

Malek Ayoub: Nothing to disclose Shivani Mattay: Nothing to disclose Andres J. Yarur: Advisory board and/or consultant Takeda, Pfizer, Arena, Abbvie, Bristol Myers Squibb and Celltrion. Parakkal Deepak: Consultant or on an advisory board for Janssen, Pfizer, Prometheus Biosciences, Boehringer Ingelheim, AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, CorEvitas LLC and Sandoz. He has also received funding under a sponsored research agreement unrelated to the data in the paper from Janssen, Abbvie, Takeda Pharmaceutical, Pfizer/Arena Pharmaceuticals, Bristol Myers Squib, Boehringer Ingelheim, Teva Pharmaceuticals, Landos Pharmaceuticals and Agomab.

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Ayoub, M., Mattay, S., Yarur, A.J. et al. Managing Risks with Newer Oral Small Molecules in Patients with Inflammatory Bowel Diseases. Curr Gastroenterol Rep 26, 145–156 (2024). https://doi.org/10.1007/s11894-024-00923-x

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