The Drug-Induced Respiratory Disease Website

Tofacitinib

Pulmonary arterial hypertension

May reverse with drug discontinuation. Generally similar to primary PHTn clinically, hemodynamically and on pathology. PMID 23997051. A few cases are thromboembolic in nature (PMID 24881082). Reviews at PMID 29508628, 30545968

Publications

Habib P, Podgorski M, Adorini K, Brown M, McLean A, Tjeuw M, Joshua F, Ng B

First Reported Case of Pulmonary Arterial Hypertension Secondary to Tofacitinib Treatment for Undifferentiated Arthritis.

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 2018 Oct 23;; — 2018 Oct 23

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

Diagnosing DIRD

Identify causative drugs

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