Use of Sotatercept to Facilitate Transition From Intravenous to Oral Prostacyclin Therapy

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary vascular resistance (PVR) leading to right ventricular failure and high mortality. Parenteral prostacyclin therapy remains the cornerstone for high-risk patients but is limited by complications and reduced quality of life. Sotatercept, an activin signaling inhibitor, has recently emerged as an effective adjunct therapy in PAH, improving functional and hemodynamic outcomes. This case series evaluated whether the addition of sotatercept could facilitate the transition from intravenous (IV) to oral prostacyclin in eight high-risk PAH patients who had previously failed transition attempts. All patients received background dual therapy with endothelin receptor antagonists and phosphodiesterase-5 inhibitors and were transitioned from IV to oral treprostinil following the fifth dose of sotatercept. At 24 weeks, all eight patients successfully maintained oral therapy without re-initiation of IV prostacyclin. Significant improvements were observed in 6-min walk distance, WHO functional class, right ventricular systolic pressure, and PVR. No treatment discontinuations or serious adverse events occurred. These findings suggest that adjunctive sotatercept may enable safe and effective transition from parenteral to oral prostacyclin therapy, expanding treatment flexibility and improving quality of life in high-risk PAH patients. Prospective studies are warranted to confirm long-term outcomes.