- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Important Clinical Considerations for Pulmonary Arterial Hypertension
Panelists discuss how prostacyclin pathway treatments remain important but challenging due to significant side effects and delivery complexity, with sotatercept potentially reducing reliance on parenteral prostacyclins while maintaining their role in high-risk patients with low cardiac output.
EP: 1.Pathophysiology of Pulmonary Arterial Hypertension
EP: 2.Differential Diagnosis of Pulmonary Arterial Hypertension
EP: 3.Importance of Early Detection and Monitoring for Disease Progression
EP: 4.Risk Stratification and the Importance of Patient-Centered Care
EP: 5.Strengths and Limitations of Current Therapeutic Options
EP: 6.Overview of Different Therapies for Patients with Pulmonary Arterial Hypertension
EP: 7.Sotatercept for Patients with Pulmonary Arterial Hypertension
EP: 8. The Role of the Prostacyclin Pathway
EP: 9.Important Clinical Considerations for Pulmonary Arterial Hypertension
EP: 10.Economic Impact of Pulmonary Arterial Hypertension
EP: 11.Barriers to Care for Patients with Pulmonary Arterial Hypertension
EP: 12.Utilizing Health Economic Outcomes in Clinical Practice
EP: 13.Outlining the Need for Equitable Access to Care
EP: 14.Final Panelist Thoughts on the Management of Pulmonary Arterial Hypertension
Clinical Trial Evidence and Treatment Evolution
The STELLAR study demonstrated sotatercept's efficacy in a mature patient population with an average disease duration of nine years, heavily pretreated with 2-3 agents and 40% receiving infusion therapy. Despite this advanced disease state, sotatercept addition showed dramatic improvements in exercise capacity, symptoms, NT-proBNP levels, and hemodynamics, with mean pressure reductions not seen since early prostacyclin analog trials. Clinical experience has largely recapitulated these trial results with generally good tolerability.
The HYPERION trial examined early sotatercept use in newly diagnosed PAH patients within the first year, but was stopped early due to overwhelmingly positive results from another trial that eliminated equipoise for continuing placebo-controlled studies in this fatal disease. The ZENITH trial specifically targeted high-risk patients with REVEAL scores ≥9, a population typically excluded from clinical trials due to severe illness and potential inability to tolerate investigational agents.
ZENITH results showed sotatercept reduced clinical worsening by 76% in high-risk patients, using a high bar endpoint of death, transplantation, or hospitalization rather than softer disease progression measures used in other studies. This evidence supports sotatercept use across the PAH risk spectrum, from newly diagnosed patients to those with advanced disease, potentially changing treatment paradigms and timing of therapeutic interventions.
Integrated Care for Chronic Conditions: A Randomized Care Management Trial
December 3rd 2025The authors sought to understand the differential impact of payer-led community-based care management approaches on stakeholder-oriented outcomes for publicly insured adults with multiple chronic conditions.
Read More
Managed Care Reflections: A Q&A With A. Mark Fendrick, MD, and Michael E. Chernew, PhD
December 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.
Read More
