Journal Article

Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension

Meyer, Gisela, Miller, Barry, Grünig, Ekkehard, Fowler, Marcie, Koglin, Joerg, Humbert, Marc, Olsson, Karen M., Butler, John, Xu, Yayun, de Oliveira Pena, Janethe, Badesch, David B., Waxman, Aaron B., Hoeper, Marius M., Kopeć, Grzegorz, Souza, Rogerio, Gibbs, J. Simon R., Gomberg-Maitland, Mardi, McLaughlin, Vallerie V., Rosenkranz, Stephan, Preston, Ioana R., Ghofrani, H. Ardeschir

2023

Overview

Pulmonary arterial hypertension is a progressive disease involving proliferative remodeling of the pulmonary vessels. Despite therapeutic advances, the disease-associated morbidity and mortality remain high. Sotatercept is a fusion protein that traps activins and growth differentiation factors involved in pulmonary arterial hypertension. We conducted a multicenter, double-blind, phase 3 trial in which adults with pulmonary arterial hypertension (World Health Organization [WHO] functional class II or III) who were receiving stable background therapy were randomly assigned in a 1:1 ratio to receive subcutaneous sotatercept (starting dose, 0.3 mg per kilogram of body weight; target dose, 0.7 mg per kilogram) or placebo every 3 weeks. The primary end point was the change from baseline at week 24 in the 6-minute walk distance. Nine secondary end points, tested hierarchically in the following order, were multicomponent improvement, change in pulmonary vascular resistance, change in N-terminal pro-B-type natriuretic peptide level, improvement in WHO functional class, time to death or clinical worsening, French risk score, and changes in the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT) Physical Impacts, Cardiopulmonary Symptoms, and Cognitive/Emotional Impacts domain scores; all were assessed at week 24 except time to death or clinical worsening, which was assessed when the last patient completed the week 24 visit. A total of 163 patients were assigned to receive sotatercept and 160 to receive placebo. The median change from baseline at week 24 in the 6-minute walk distance was 34.4 m (95% confidence interval [CI], 33.0 to 35.5) in the sotatercept group and 1.0 m (95% CI, -0.3 to 3.5) in the placebo group. The Hodges-Lehmann estimate of the difference between the sotatercept and placebo groups in the change from baseline at week 24 in the 6-minute walk distance was 40.8 m (95% CI, 27.5 to 54.1; P<0.001). The first eight secondary end points were significantly improved with sotatercept as compared with placebo, whereas the PAH-SYMPACT Cognitive/Emotional Impacts domain score was not. Adverse events that occurred more frequently with sotatercept than with placebo included epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure. In patients with pulmonary arterial hypertension who were receiving stable background therapy, sotatercept resulted in a greater improvement in exercise capacity (as assessed by the 6-minute walk test) than placebo. (Funded by Acceleron Pharma, a subsidiary of MSD; STELLAR ClinicalTrials.gov number, NCT04576988.).

• Publisher: Massachusetts Medical Society
• Subject: Adult / Apoptosis / Blood pressure / Body weight / Brain natriuretic peptide / Cardiology / Cardiology General / Cardiovascular Agents - administration & dosage / Cardiovascular Agents - adverse effects / Cardiovascular Agents - pharmacology / Cardiovascular Agents - therapeutic use / Clinical Medicine / Clinical Medicine General / Clinical trials / Cognitive ability / Committees / Critical Care / Critical Care General / Double-Blind Method / Emotions / Exercise Tolerance - drug effects / Functional morphology / Fusion protein / Hemodynamics / Hemoglobin / Humans / Hypertension / Hypertension, Pulmonary - drug therapy / Injections, Subcutaneous / International organizations / Life Sciences / Ligands / Morbidity / Outpatient-Based Clinical Medicine / Patients / Placebos / Pulmonary / Pulmonary Arterial Hypertension - diagnosis / Pulmonary Arterial Hypertension - drug therapy / Pulmonary arteries / Pulmonary Hypertension / Recombinant Fusion Proteins - administration & dosage / Recombinant Fusion Proteins - adverse effects / Recombinant Fusion Proteins - pharmacology / Recombinant Fusion Proteins - therapeutic use / Respiratory System Agents - administration & dosage / Respiratory System Agents - adverse effects / Respiratory System Agents - pharmacology / Respiratory System Agents - therapeutic use / Signal transduction / Thrombocytopenia / Treatment Outcome / Vascular Resistance - drug effects / Veins & arteries / Walk Test