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Real members of myPHteam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

what exactly are the differences in therapy between PH and PAH? Where does Sotatercept come in?

A myPHteam Member asked a question 💭
Mangawhai
May 5
 · 
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A myPHteam Member

Hello...Here in the States, we don't yet have any government approved medicines for the 4 out of the 5 sub-groups of PH that aren't PAH. It might be different in New Zealand...but here, Sotatercept (brand name Winrevair in the US) which is currently widely used as the fourth treatment pathway for PAH, is being tested to be used for some patients in Group 2 that overlap a little with PAH. I'm one of those people so I am hoping to get included in the government testing trials coming up for that medication.

Each medication treatment available for PAH targets a specific "pathway" and generally, PAH patients must be on at least 2 other pathway meds before they can be prescribed Sotatercept and then they will be on all those meds coinciding. If Sotatercept gets approved for use by group 2 patients, it will be a stand along treatment as right now, the only way to treat Group 2 patients is by treating the underlying cause which is Left Heart Disease.

May 5 (edited)
myPHteam

Great question! While PH and PAH are related, their treatment approaches can differ. Here's a breakdown:

PH (Pulmonary Hypertension) is a broad term for high blood pressure in the lung arteries. Treatment depends on the underlying cause and may vary widely.

PAH (Pulmonary Arterial Hypertension) is a specific type of PH Show Full Answer

Great question! While PH and PAH are related, their treatment approaches can differ. Here's a breakdown:

PH (Pulmonary Hypertension) is a broad term for high blood pressure in the lung arteries. Treatment depends on the underlying cause and may vary widely.

PAH (Pulmonary Arterial Hypertension) is a specific type of PH where the small lung arteries become narrow and stiff. Because the cause is more defined, there are FDA-approved medications that directly target the disease pathways. For PAH specifically, doctors often use combination therapy — two or more medications targeting different pathways at once. The main medication types include:

- ERAs – relax blood vessels by blocking a tightening protein called endothelin
- PDE5 inhibitors – widen blood vessels using nitric oxide
- Prostacyclin medications – mimic natural substances that relax blood vessels Where does sotatercept (Winrevair) fit in?

Approved by the FDA in March 2024, sotatercept targets a fourth pathway called the activin pathway — something older PAH medications don't address.

In PAH, excess activin causes lung blood vessel cells to multiply and stiffen. Sotatercept traps and neutralizes activin, helping restore balance. When added to existing therapy, it has shown:

- Improved exercise capacity
- Slowed disease progression
- Reduced risk of death, lung transplant, and hospitalizations (particularly in more advanced PAH)

It's not suitable for everyone, so a conversation with your care team is the best next step to see if it's right for you.

May 5

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