ERS recommends add-on sotatercept across three risk strata in PAH, and sugammadex edges neostigmine on postoperative pulmonary complications

The edition in brief

An ERS Task Force has updated its pulmonary arterial hypertension treatment guideline using GRADE methodology. It recommends add-on sotatercept, an activin signalling inhibitor, for patients already on PAH drugs who are at intermediate-low, intermediate-high or high risk of death, based on high certainty of evidence; no recommendation is made for low-risk patients because the evidence is of low certainty and few such patients entered the trials. It also suggests right heart catheterisation during follow-up in the same three risk strata where therapeutic consequences are expected. A matching-adjusted indirect comparison of three mepolizumab trials against two dupilumab trials in COPD with an eosinophilic phenotype found no significant difference in annualised moderate or severe exacerbation rate (rate ratio 0.91, 95% CI 0.60-1.37 by investigator-assessed chronic bronchitis; 1.13, 0.80-1.58 by questionnaire definition) or quality of life. In 3,370 PAP-treated patients with moderate-to-severe obstructive sleep apnoea followed for a median nine years, adherence was associated with lower major adverse cardiovascular events (adjusted HR 0.53, 95% CI 0.46-0.62), with a stronger association in those with high hypoxic burden or heart-rate response (interaction HR 0.61, 0.43-0.87). The AZIMUNE trial of 40 adults with uncontrolled asthma found azithromycin raised rhinovirus-induced epithelial interferon-beta and interferon-lambda and lowered IL-33, without significant clinical differences. The edition closes on SNaPP, in which sugammadex reduced postoperative pulmonary complications or death from 21.5% to 19.0% across 3,498 patients.