Drug-induced pulmonary arterial hypertension: a primer for clinicians and scientists

Abstract

Drug-induced pulmonary arterial hypertension (D-PAH) is a form of World Health Organization Group 1 pulmonary hypertension (PH) defined by severe small vessel loss and obstructive vasculopathy, which leads to progressive right heart failure and death. To date, 16 different compounds have been associated with D-PAH, including anorexigens, recreational stimulants, and more recently, several Food and Drug Administration-approved medications. Although the clinical manifestation, pathology, and hemodynamic profile of D-PAH are indistinguishable from other forms of pulmonary arterial hypertension, its clinical course can be unpredictable and to some degree dependent on removal of the offending agent. Because only a subset of individuals develop D-PAH, it is probable that genetic susceptibilities play a role in the pathogenesis, but the characterization of the genetic factors responsible for these susceptibilities remains rudimentary. Besides aggressive treatment with PH-specific therapies, the major challenge in the management of D-PAH remains the early identification of compounds capable of injuring the pulmonary circulation in susceptible individuals. The implementation of pharmacovigilance, precision medicine strategies, and global warning systems will help facilitate the identification of high-risk drugs and incentivize regulatory strategies to prevent further outbreaks of D-PAH. The goal for this review is to inform clinicians and scientists of the prevalence of D-PAH and to highlight the growing number of common drugs that have been associated with the disease.

Impact of Nutrition on Pulmonary Arterial Hypertension

“…5, have also been identified in PAH patients [13]. Numerous drugs and substances have been involved in the development of PAH, including anorexigens, selective serotonin reuptake inhibitors, interferons, antiviral therapies, chemotherapeutic agents, and tyrosine kinase inhibitors such as dasatinib [3,14]. Finally, PAH is also associated with other systemic disorders, such as connective tissue diseases and portal hypertension, and infections, such as HIV and schistosomiasis [3].…”

Pulmonary hypertension: From an orphan disease to a global epidemic

“…The true prevalence of clinical pulmonary hypertension in HIV patients is likely to vary according to regional differences because of differences in environmental, cultural, and genetic factors 135 . The condition can be exacerbated by using addictive drugs found in many herbal remedies in the developing regions 137 . Furthermore, co-exposure with more than one infection can be an issue.…”

Pulmonary arterial hypertension in breast cancer patients on HER2-targeted therapy: a review of FDA Adverse Events Reporting System data

“…The World Health Organization (WHO) classifies drug-and toxin-induced pulmonary arterial hypertension (D-PAH) as a form of Group 1 pulmonary hypertension. Pulmonary arterial hypertension (PAH) refers to pathological remodelling of the pulmonary vasculature, which carries a poor prognosis if left untreated [1,2]. The incidence and prevalence of PAH observed with therapies that target human epidermal growth factor 2 (HER2) may be underreported.…”