Pulmonary vascular disease & thromboembolism

Sotatercept for Pulmonary Arterial Hypertension within the First Year after Diagnosis

N Engl J MedPublished Randomised controlled trial

Primary result · Clinical worseningResult — go to the resultHazard ratio 0.24 95% CI 0.14–0.41
  • stopped early
  • Stopped early owing to loss of clinical equipoise after positive results from previous sotatercept trials

Authors' conclusion

Among adults with pulmonary arterial hypertension who had received the diagnosis less than 1 year earlier, the addition of sotatercept to background therapy resulted in a lower risk of clinical worsening than placebo.

Study context

Population
Adults with WHO functional class II or III pulmonary arterial hypertension diagnosed <1 year earlier, at intermediate or high risk of death, on double or triple background therapymedian follow-up 13.2 months
Participants
320 adults
Comparison
Add-on sotatercept vs placebo
  • Sotaterceptn = 160
  • Placebon = 160reference
Primary endpoint
Clinical worsening (death from any cause, unplanned hospitalization ≥24 h for worsening PAH, atrial septostomy, lung transplantation, or deterioration in exercise testing due to PAH), time to first event
Methodological detailsphase 3, placebo-controlled
  • Phase 3
  • Placebo-controlled

Primary result

Clinical worsening

Hazard ratio

0.24

95% CI 0.14–0.41

P < 0.001

Events by treatment group

Sotatercept vs Placebo
HR 0.24 (95% CI 0.14–0.41); P < 0.001

As reported in the abstract

Further findings

Deterioration in exercise testing due to PAH

Unplanned hospitalization for worsening PAH

Death from any cause

Atrial septostomy or lung transplantation

No cases occurred

Safety

Most common adverse events with sotatercept
31.9% · Epistaxis · Telangiectasia 26.2%

Original publication

Sotatercept for Pulmonary Arterial Hypertension within the First Year after Diagnosis. N Engl J Med. Published 30 September 2025. doi:10.1056/nejmoa2508170

Summarised from the published abstract; every number is checked against it

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