Tofacitinib-Induced Acute Pancreatitis

• Published in: Drug safety Vol. 45; no. 10; p. 1161
• Main Authors: Belgacem, M B, Zaiem, A, Charfi, O, Mahjoubi, Y, Daldoul, M, Aidli, S E, Daghfous, R
• Format: Journal Article
• Language: English
• Published: Auckland Springer Nature B.V 01.10.2022
• Subjects: Arthritis; Biocompatibility; Captopril; Computed tomography; Hypertension; Immunosuppressive agents; Inflammatory bowel diseases; Pain; Pancreatitis; Patients; Rheumatoid arthritis; Tumors; Vomiting
• ISSN: 0114-5916; 1179-1942

Introduction: Tofacitinib is an oral active immunosuppressant drug mainly indicated in rheumatoid arthritis (RA), inflammatory bowel disease1. It is generally well tolerated. However, some adverse reactions (ADR) were reported. The most common ADR are severe infection, malign and benign tumors and thrombotic events. Pancreatitis has never been reported. Objective: We report an exceptional case of pancreatitis associated with tofacitinib. Methods: A 57-year-old female was treated since 2017 with captopril 50mg/day for hypertension and by several immunosuppressive treatment for rheumatoid arthritis (RA). On February, 14th 2022, for RA therapeutic failure, the patient started a new treatment based on tofacitinib 10mg daily. On February 20th, the patient presented acute abdominal pain with vomiting. Abdominal CT scan was performed in spite of a sub-normal biological tests (including the serum amylase and lipase level) showing a grade C pancreatitis. Etiologic investigations were normal including metabolic and lithiasic origin. The newly introduced drug (tofacitinib) was withdrawn. The patient presented a rapid clinical improvement with no recurrence of pancreatitis episode after 3 months of follow-up. Results: The responsibility of tofacitinib was retained with an imputation score of I4 (C2, S2)3 mainly because of a compatible delay, the favorable outcome following its withdrawal (tofacitinib was the only drug stopped), and the negative investigations. Pancreatitis is reported with immunosuppressive drugs. However, this ADR is not associated with the new anti-JAK, especially tofacitinib. The mechanism is generally either toxic or immunologic. In this case, the mechanism seems to be toxic since the short delay of occurrence and the absence of immunologic symptoms. Conclusion: This observation reported an exceptional case of pancreatitis induced by tofacitinib. The probable mechanism is toxic.