Introduction:
Tofacitinib is approved for moderately to severely active ulcerative colitis (UC).1 Animal studies showed increased pregnancy loss, lower foetal weight, and congenital malformations; the doses used were much higher than the maximum recommended dose of 10mg twice daily in humans.2 The only evidence for use in pregnancy in patients with inflammatory bowel disease (IBD) is from the registration studies, which revealed 11 maternal exposures with foeto-maternal adverse events rates comparable to the general population and patients with similar conditions not taking tofacitinib; however, the number of cases was small, the comparison was indirect, and subjects received pre-emptive pregnancy testing at every study visit to permit early treatment cessation.3 Until further advice is available, tofacitinib should be avoided in pregnancy.4
We present a case of exposure to tofacitinib in the first trimester until six weeks of gestation in a patient with UC.