The lipid profile should be monitored in this patient with rheumatoid arthritis who began taking tofacitinib 1 month ago. Elevation of all components of the lipid panel, including cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol, has been found to occur as rapidly as 1 month after initiation of therapy with the biologic agent tofacitinib. Generally, these elevations remain stable over time. In the first 3 months of clinical trials evaluating the efficacy of tofacitinib, mean LDL cholesterol increased by 15%, and mean HDL cholesterol increased by 10%. In a subsequent clinical trial, statin therapy resulted in a return to pretreatment levels of LDL cholesterol. It is unknown to what extent these lipid abnormalities may impact the long-term risk of cardiovascular disease in patients treated with tofacitinib. Tofacitinib may initially raise then lower leukocyte counts. Furthermore, lymphopenia, neutropenia, and anemia may be seen with long-term use.

Elevated aminotransaminase levels may be seen with exposure to tofacitinib. However, abnormalities of bilirubin, glucose, and alkaline phosphatase would not be expected to result from exposure to 1 month of therapy with tofacitinib.