A Case Series: Pericardial Effusion in Patients Treated With Sotatercept

Pulmonary arterial hypertension (PAH) is characterized by vasoconstriction, proliferation, fibrosis, and microthrombosis of the pulmonary vasculature, which causes elevated pulmonary arterial pressure and vascular resistance leading to right ventricular failure and death. Previous treatments targeted three known pathways involved in the development of PAH: endothelin, nitric oxide, and prostacyclin. Dysfunctional signaling of the transforming growth factor-beta (TGF-β) family, via bone morphogenetic protein (BMP) receptor 2 and activin signaling, has also been implicated in PAH leading to the development of a new class of therapies. Sotatercept, the first medication in this class, has shown significant promise as an add-on therapy. Another drug in the class, cibotercept, is under investigation; however, the clinical trial has been suspended because of the development of pericardial effusions in some patients. In light of this new finding, we investigated whether our patients treated with sotatercept also experienced this possible side effect.