Integrating Sotatercept Into PAH Care: Vallerie McLaughlin, MD

Sotatercept (Winrevair; Merck) is enhancing treatment for patients with pulmonary arterial hypertension (PAH), explained Vallerie McLaughlin, MD, the Kim A. Eagle M.D. Endowed Professor of Cardiovascular Medicine and professor of internal medicine at the University of Michigan Medical School.

McLaughlin presented the results of a pooled analysis of the PULSAR, STELLAR, and ZENITH trials of sotatercept in PAH at the 2025 American Heart Association Scientific Sessions, held in New Orleans, Louisiana, November 7-10, 2025.

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Transcript

How does combining sotatercept with established treatments aim to address the limitations of prior monotherapies or combination regimens?

We are so fortunate to have so many therapies for PAH, and we use combination therapy all the time. We've had medicines from 3 different pathways for decades, and even though we use those medicines in combination, we still lose far too many patients to this disease. We now have many trials demonstrating the benefit of adding sotatercept, or Winrevair, to that conventional therapy. In fact, the patients in these trials were very highly pretreated with those other conventional therapies and still experienced a benefit from the addition of sotatercept.

In your clinical experience, which patients with PAH—low-risk, intermediate-risk, or high-risk—do you believe stand to benefit most significantly from the immediate addition of sotatercept?

When we think about therapy for our patients, there are many things we consider, including their risk status. Certainly, patients who aren't achieving low-risk [status] need additional therapy, and we consider sotatercept in those patients. But there are many patients who technically meet low-risk [status] but still have a high burden of disease, still have bad RV [right ventricular] dysfunction that we also consider it in.

Every time I see a patient, no matter what the risk category is, I think, “How can I optimize this patient's long-term outcomes?” And I'm often thinking about whether or not sotatercept is an appropriate therapy in that patient.