Parenteral prostacyclin therapy remains the cornerstone for high-risk pulmonary arterial hypertension (PAH) patients but is limited by complications and reduced quality of life. A case series of eight high-risk patients demonstrated that adding sotatercept successfully enabled transition from intravenous to oral prostacyclin therapy. All patients received background dual therapy with endothelin receptor antagonists and phosphodiesterase-5 inhibitors and were transitioned from Intravenous to oral treprostinil following the fifth dose of sotatercept.
After 24 weeks, all patients maintained oral therapy with significant improvements in exercise capacity (6-minute walk distance), World Health Organisation (WHO) functional class, and hemodynamic measures (right ventricular pressure and pulmonary vascular resistance). No serious adverse events or treatment discontinuations occurred. These findings suggest sotatercept may offer a promising strategy to transition high-risk pulmonary arterial hypertension patients from parenteral to oral therapy, potentially improving quality of life while maintaining clinical benefits.
The authors point out that current pulmonary arterial hypertension treatment strategies lack clear guidance on therapy de-escalation. The findings of this limited case series underscore the need for formalized de-escalation guidelines and criteria to identify suitable patients for therapy reduction, which could optimize long-term disease management.
Larger, diverse, long-term prospective studies are of course needed to confirm these observations and establish evidence-based de-escalation protocols.
Read more at this link on the Clinical Respiratory Journal
Citation
Dagher C, Akiki M, Swanson K, Carollo B, Chernobelsky E, Farber HW, Parikh R. Use of Sotatercept to Facilitate Transition From Intravenous to Oral Prostacyclin Therapy. Clin Respir J. 2025 Dec;19(12):e70149. doi: 10.1111/crj.70149. PMID: 41437481; PMCID: PMC12728122.