A European Respiratory Society task force updated its treatment guidelines for pulmonary arterial hypertension, focusing on sotatercept, an activin signalling inhibitor, and on right heart catheterisation during follow-up. It followed ERS methods and GRADE, with four PICO questions and one narrative question.
The task force recommends adding sotatercept in patients already on PAH drugs who are at intermediate-low, intermediate-high or high risk of death, based on high-certainty evidence from randomised trials. It gives no recommendation for patients at low risk, because evidence is limited and few such patients were enrolled. Patients on sotatercept should be managed in pulmonary hypertension centres with regular follow-up. It also suggests right heart catheterisation during follow-up in patients at intermediate or high risk when the result is expected to change treatment, with no recommendation for low-risk patients.
The abstract does not give effect sizes. Cost and availability in India are not discussed, and sotatercept's status here is not stated. For most clinicians the relevant message is to refer promptly and to risk-stratify patients at every review, since risk category determines what the guideline recommends.
- Refer suspected or confirmed PAH to a pulmonary hypertension centre; the guideline advises sotatercept be managed there.
- Risk-stratify at each follow-up; the recommendation depends on the risk category.
- Ask the centre whether right heart catheterisation is planned when treatment change is expected.
- Check availability and cost locally; the guideline does not address either.
- Do not start or stop PAH therapy outside specialist advice.
Why it matters
It moves a new drug class from trials into formal European guidance for patients who are not yet at low risk.
Don't overread it
A guideline recommendation is not a licence or an access decision, and the abstract gives no effect sizes or information on availability in India.
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