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Trade names | Winrevair |
Other names | ACE-011, MK-7962, sotatercept-csrk |
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Routes of administration | Subcutaneous |
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Chemical and physical data | |
Formula | C3448H5264N920O1058S42 |
Molar mass | 77879.94 g·mol−1 |
Sotatercept, sold under the brand name Winrevair is a medication used for the treatment of pulmonary arterial hypertension. [1] It is an activin signaling inhibitor, [1] based on the extracellular domain of the activin type 2 receptor expressed as a recombinant fusion protein with immunoglobulin Fc domain (ACTRIIA-Fc). [3] It is given by subcutaneous injection. [1]
Sotatercept was approved for medical use in the United States in March 2024, [1] [4] [5] and in the European Union in August 2024. [6]
In the United States, sotatercept is indicated for the treatment of adults with pulmonary arterial hypertension (PAH, WHO Group 1). [1]
In the European Union, sotatercept, in combination with other pulmonary arterial hypertension therapies, is indicated for the treatment of pulmonary arterial hypertension in adults with WHO Functional Class (FC) II to III, to improve exercise capacity. [2]
The most common adverse reactions include headache, epistaxis, rash, telangiectasia, diarrhea, dizziness, and erythema. [1]
In June 2024, the Committee for Medicinal Products for Human Use of the European Medicines Agency adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Winrevair, intended for the treatment of pulmonary arterial hypertension. [2] [7] [8] The applicant for this medicinal product is Merck Sharp & Dohme B.V. [2] Sotatercept was approved for medical use in the European Union in August 2024. [2] [6]
Following its approval in 2024, the list price of Winrevair as single-vial and double-vial kit was announced at US$14,000 per vial, with an estimated annual cost of $240,000 a year. [9]
Sotatercept is the international nonproprietary name. [10] [11]
It was initially developed to increase bone density [12] but during its early development was found to increase hemoglobin and red blood cell counts, [13] and was subsequently studied for use in anemia associated with multiple conditions including beta thalassemia and multiple myeloma. [14] [15] [16] Development of this drug was superseded by the development of luspatercept (Reblozyl), a modified activin receptor type 2B (ACTRIIB-Fc) based ligand trap with improved properties for anemia. [17] Hypothesizing that this drug might block the effects of activin in promoting pulmonary vascular disease, this molecule was found to inhibit vascular obliteration in multiple models of experimental pulmonary hypertension, providing rationale to reposition sotatercept for PAH in the PULSAR and STELLAR clinical trials for PAH. [18]
Pulmonary hypertension is a condition of increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, fainting, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual. According to the definition at the 6th World Symposium of Pulmonary Hypertension in 2018, a patient is deemed to have pulmonary hypertension if the pulmonary mean arterial pressure is greater than 20mmHg at rest, revised down from a purely arbitrary 25mmHg, and pulmonary vascular resistance (PVR) greater than 3 Wood units.
Sitaxentan sodium (TBC-11251) is a medication for the treatment of pulmonary arterial hypertension (PAH). It was marketed as Thelin by Encysive Pharmaceuticals until Pfizer purchased Encysive in February 2008. In 2010, Pfizer voluntarily removed sitaxentan from the market due to concerns about liver toxicity.
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Dasatinib, sold under the brand name Sprycel among others, is a targeted therapy medication used to treat certain cases of chronic myelogenous leukemia (CML) and acute lymphoblastic leukemia (ALL). Specifically it is used to treat cases that are Philadelphia chromosome-positive (Ph+). It is taken by mouth.
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Ambrisentan, sold under the brand name Letairis among others, is a drug used for the treatment of pulmonary hypertension. It is an endothelin receptor antagonist.
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Ifetroban is a potent and selective thromboxane receptor antagonist. It has been studied in animal models for the treatment of cancer metastasis, myocardial ischemia, hypertension, stroke, thrombosis, cardiomyopathy, and for its effects on platelets. Clinical trials are evaluating the therapeutic safety and efficacy of oral ifetroban capsules for the treatment of cancer metastasis, cardiovascular disease, aspirin exacerbated respiratory disease, systemic sclerosis, and Duchenne muscular dystrophy.
Actelion Pharmaceuticals Ltd. is a pharmaceuticals and biotechnology company established in December 1997, headquartered in Allschwil near Basel, Switzerland.
Macitentan, sold under the brand name Opsumit, is an endothelin receptor antagonist developed by Actelion and approved for the treatment of pulmonary arterial hypertension (PAH). Macitentan is a dual endothelin receptor antagonist, meaning that it acts as an antagonist of two endothelin (ET) receptor subtypes, ETA and ETB. However, macitentan has a 50-fold increased selectivity for the ETA subtype compared to the ETB subtype.
Selexipag, sold under the brand name Uptravi, is a medication developed by Actelion for the treatment of pulmonary arterial hypertension (PAH). Selexipag and its active metabolite, ACT-333679, are agonists of the prostacyclin receptor, which leads to vasodilation in the pulmonary circulation. It is taken by mouth or administered intravenously.
Fluralaner, (INN) sold under the brand name Bravecto among others, is a systemic insecticide and acaricide that is administered orally or topically. The US Food and Drug Administration (FDA) approved it for flea treatment in dogs in May 2014, and approved the combination fluralaner/moxidectin as a topical treatment for cats in November 2019. The EU approved fluralaner in March 2014. Australia approved it for the treatment and prevention of ticks and fleas on dogs in January 2015. For treating mites in chickens, a solution for use in drinking water is available under the brand name Exzolt and was approved for use in the EU in 2017.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term disease caused by a blockage in the blood vessels that deliver blood from the heart to the lungs. These blockages cause increased resistance to flow in the pulmonary arterial tree which in turn leads to rise in pressure in these arteries. The blockages either result from organised blood clots that usually originate from the deep veins of the lower limbs of the body (thromboembolism) and lodge in the pulmonary arterial tree after passing through the right side of the heart. The blockages may also result from scar tissue that forms at the site where the clot has damaged the endothelial lining of the pulmonary arteries, causing permanent fibrous obstruction. Most patients have a combination of microvascular and macrovascular obstruction. Some patients may present with normal or near-normal pulmonary pressures at rest despite symptomatic disease. These patients are labelled as having chronic thromboembolic disease (CTED).
Roxadustat, sold under the brand name Evrenzo, is an anti-anemia medication. Roxadustat is a HIF prolyl-hydroxylase inhibitor that increases endogenous production of erythropoietin and stimulates production of hemoglobin and red blood cells. It was investigated in clinical trials for the treatment of anemia caused by chronic kidney disease (CKD). It is taken by mouth. The drug was developed by FibroGen, in partnership with AstraZeneca.
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Clinical trial number NCT04576988 for "A Study of Sotatercept for the Treatment of Pulmonary Arterial Hypertension (MK-7962-003/A011-11)(STELLAR)" at ClinicalTrials.gov