Pericardial effusions and sotatercept therapy in pulmonary arterial hypertension: a multicentre, real-world experience

Sotatercept, an activin signaling inhibitor (ASI), was recently approved to treat pulmonary arterial hypertension (PAH)[1, 2]. Sotatercept improves exercise capacity and reduces morbidity and mortality[3–5]. Four common side effects associated with sotatercept use in the pivotal clinical trials[4] include polycythemia (6%), thrombocytopenia, (6%), telangiectasia (10%), and bleeding events (20%). Potentially related to telangiectasias, a rare but serious complication of severe hypoxemia and intrapulmonary shunting was recently reported [6]. A phase 2 trial (TROPOS) of cibotercept, another ASI, for the treatment of PAH, was recently halted due to multiple occurrences of unanticipated pericardial effusions in patients in the treatment arm[7]. However, development of pericardial effusions was not significantly higher with sotatercept therapy in the landmark trials[3–5]. In this multicenter case series, we report multiple instances of clinically significant moderate to large pericardial effusions in PAH patients treated with sotatercept.