Recurrent Gastrointestinal Bleeding in a Patient With Pulmonary Arterial Hypertension Treated With Sotatercept

Letters2 January 2024Recurrent Gastrointestinal Bleeding in a Patient With Pulmonary Arterial Hypertension Treated With SotaterceptAaron Hakim, MD, MS, Zachary P. Fricker, MD, Joseph D. Feuerstein, MD, Harrison W. Farber, MD*, Noah C. Schoenberg, MD*Aaron Hakim, MD, MSDepartment of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, Zachary P. Fricker, MDDepartment of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Joseph D. Feuerstein, MDDepartment of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Harrison W. Farber, MD*Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts, Noah C. Schoenberg, MD*Department of Medicine and Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L23-0387 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: In the phase 2 clinical trial PULSAR, sotatercept markedly reduced pulmonary vascular resistance in patients receiving background therapy for pulmonary arterial hypertension (1). In the phase 3 clinical trial STELLAR, the addition of sotatercept significantly improved exercise capacity as assessed by the 6-minute walk test compared with placebo; multiple additional secondary end points were also achieved (2). In the PULSAR and STELLAR trials, epistaxis, skin telangiectasias, and thrombocytopenia were more frequent among those taking sotatercept compared with placebo (1, 2). In STELLAR, one instance of gastrointestinal bleeding was noted in the treatment group; to date, sotatercept has not been ...References1. Humbert M, McLaughlin V, Gibbs JSR, et al. PULSAR Trial Investigators. Sotatercept for the treatment of pulmonary arterial hypertension. N Engl J Med. 2021;384:1204-1215. [PMID: 33789009] doi:10.1056/NEJMoa2024277 CrossrefMedlineGoogle Scholar2. Hoeper MM, Badesch DB, Ghofrani HA, et al; STELLAR Trial Investigators. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med. 2023;388:1478-1490. [PMID: 36877098] doi:10.1056/NEJMoa2213558 CrossrefMedlineGoogle Scholar3. Babbs K, Materna C, Fisher E, et al. RKER-012, a novel activin receptor type IIB ligand trap, reduced cardiac and pulmonary pathology in a Sugen-hypoxia model of pulmonary arterial hypertension [Abstract]. In: Proceedings of the PHA 2022 International Pulmonary Hypertension Conference, Atlanta, Georgia, 9–12 June 2022. Adv Pulm Hypertens; 2023;22:32. Google Scholar4. Wooderchak-Donahue WL, McDonald J, O'Fallon B, et al. BMP9 mutations cause a vascular-anomaly syndrome with phenotypic overlap with hereditary hemorrhagic telangiectasia. Am J Hum Genet. 2013;93:530-537. [PMID: 23972370] doi:10.1016/j.ajhg.2013.07.004 CrossrefMedlineGoogle Scholar5. García-Álvarez A, Blanco I, García-Lunar I, et al; SPHERE-HF Investigators. β3 Adrenergic agonist treatment in chronic pulmonary hypertension associated with heart failure (SPHERE-HF): a double blind, placebo-controlled, randomized clinical trial. Eur J Heart Fail. 2023;25:373-385. [PMID: 36404400] doi:10.1002/ejhf.2745 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Aaron Hakim, MD, MS; Zachary P. Fricker, MD; Joseph D. Feuerstein, MD; Harrison W. Farber, MD; Noah C. Schoenberg, MDAffiliations: Department of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDivision of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MassachusettsDepartment of Medicine and Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsNote: All authors had full access to all the data and approved the final version of this manuscript. All authors take responsibility for the integrity of the data and the accuracy of the data analysis.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L23-0387.Corresponding Authors: Aaron Hakim, MD, MS, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115; and Noah C. Schoenberg, MD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115.This article was published at Annals.org on 2 January 2024.* Drs. Farber and Schoenberg are co-senior authors. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics January 2024Volume 177, Issue 1Page: 115-117KeywordsColonoscopyDrugsEndoscopyGastrointestinal hemorrhageHospital medicineHospitalizationsPulmonary hypertension ePublished: 2 January 2024 Issue Published: January 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...