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Rethinking Pulmonary Arterial Hypertension | Myth 2: Monotherapy Is Usually Enough

General Practice

Respiratory medicine

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Description

This program is supported by an independent educational grant from MSD. This online education program is designed solely for healthcare professionals in the USA. The content is not available for HCPs in any other country.

Join PAH expert Dr. Sudarshan Rajagopal for this accredited 15-minute on-demand teaching session. Through real-world cases, Dr. Rajagopal explores common misconceptions that lead to suboptimal outcomes and demonstrates how guideline-directed, risk-based decision-making can meaningfully improve patient care.

Prefer to read instead? Read our Key Clinical Summary here.

Accreditation: AffinityCE designates this activity for 0.25 AMA PRA Category 1 Credit™

Session Highlights

Myth 2: Monotherapy Is Usually Enough

Initial improvement often does not equate to long-term stability. Most patients will not reach or maintain low-risk status on monotherapy alone. Dual or triple therapy—upfront or sequential—is frequently needed to achieve treatment goals.

Who Should Attend?

This program is for U.S. healthcare professionals involved in PAH care, including:

Pulmonologists
Cardiologists
Internal Medicine Physicians
Nurse Practitioners & Physician Assistants
Pharmacists
Nurses and other HCPs involved in the management of PAH

Faculty

Sudarshan Rajagopal, M.D., Ph.D.

Cardiologist and physician–scientist at Duke Health with expertise in pulmonary arterial hypertension and advanced heart failure. He combines clinical care with translational research focused on pulmonary vascular biology, GPCR signaling, and novel therapeutic strategies. Dr. Rajagopal plays a leading role in multidisciplinary PAH programs and is recognized for advancing mechanism-based, patient-centered approaches to cardiovascular and pulmonary vascular disease.

Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from MSD.

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

Disclosures

Sudarshan Rajagopal, MD, PhD has disclosed financial interests or relationships within the past 24 months with the following ineligible companies: Consultant for Altavant, GossamerBio, Insmed, Janssen, Liquidia, Merck, Pahr Therapeutics, United Therapeutics. Research Support from American Heart Association, Janssen, Merck, NIH, United Therapeutics. These disclosures are provided in accordance with ACCME standards to ensure transparency and uphold the integrity of continuing education. Dr. Rajagopal does not intend to reference any unlabeled or unapproved uses of products during the presentation.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. Relevant financial relationships were mitigated by the peer review of content by non-conflicted reviewers prior to the commencement of the program.

Activity Accreditation for Health Professions

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

Participation Costs

There is no cost to participate in this program.

This continuing education activity is active starting February 13th 2026, and will expire on June 28th 2027.

Estimated time to complete this activity: 15 minutes.

Disclaimer

This activity is intended for educational purposes only and does not establish a standard of care or replace clinical judgment. Any therapeutic or diagnostic strategies discussed must be evaluated in the context of each patient’s clinical circumstances, risks, and current evidence.

Learners should consult authoritative clinical guidelines and approved product information when considering treatment decisions.

All materials are used with permission. The views expressed are those of the faculty and do not necessarily reflect those of the accredited providers, MedAll, or any supporters.

Content is accurate as of the date of release.

Learning objectives

Upon completion of this activity, participants should be better able to:

Differentiate between monotherapy, dual therapy, and triple therapy approaches, highlighting their appropriate use in clinical practice.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Myth two, monotherapy is usually enough. So the learning objective here is to differentiate between monotherapy, dual therapy, and triple therapy approaches, highlighting their appropriate use in clinical practice. And I'll add one more, which is now the another common term we use, which is quad therapy. So here's the WSPH treatment algorithm again here, and you can see that after that initial risk assessment, we're gonna be providing a follow-up risk assessment, and for patients who have not achieved low risk status, we're going to consider adding therapy. And I'm just gonna highlight a few studies that have shown the benefits of adding therapy in this type of situation in patients who have not achieved low risk status. Now I will say that the majority of these studies were performed before we were doing these risk assessments regularly, so it really wasn't, we really can't say that the patients were all low risk or, or sorry, were all not low risk. Um, it was based more on the, uh, inclusion, uh, parameters for those clinical trials, which included functional class and six minute walk distance, among other parameters. So here's uh Serafin, which is the effect of macientin on disease progression. And again, 64% of these patients were on background therapy, but this was before the era of uh upfront dual oral therapy. So you can see 62% of patients were on a PD5, 5% were on a prostenoid, and you can see that adding macientin significantly improved, uh, outcomes when you're, uh, looking at, uh, this event, uh, related to PAH or death from any cause. Showing essentially the benefit of adding an ERA to preexisting therapy. Now, a similar study was performed with uh the oral IP agonist Celexae in the Griffin trial. Now here we can see uh a number of these patients are already on. Uh, ERA plus PDE5 inhibitor, but only a third, and then 47% were on ERA or PDE5 inhibitor. And you could see again, adding Celexa peg, uh, significantly improved, um, event, the event rate compared to placebo, a relative, uh, risk of 40% as a ratio of 0.60, marked improvement. And now with Hyperion, this is so Tatercept for pulmonary arterial hypertension within the first year after diagnosis. The majority of these patients were on dual oral therapy, although there were a few patients on triple therapy. You can see adding cetatercept to these patients who uh had not achieved low risk status um when at initial presentation. They're markedly reduced their risk of having an event with a hazard ratio of 0.24. Now this is, I didn't want to, uh, highlight all the other studies of so Tatters set, but this is also consistent with the results of the stellar study, which was in more of an intermediate risk population, um, and the Zenith study, which was a a primarily a high risk population. Now, uh, in both stellar and Zenith, the majority of the patients were on, uh, triple therapy, uh, to begin with, and adding cetaricept marked, uh, significantly improved outcomes. So we have a large basis for adding therapy. So, so, again, consistent with monotherapy not being enough and dual therapy not being enough for the majority of patients. So with that, I'll uh summarize my talk. The traditional stepwise approach is not sufficient, right? Standard of care for PH patients is upfront combination therapy. Monotherapy is usually never enough, as you can see from the studies I highlighted at the end, adding therapy to whatever uh uh therapies folks were on, whether it was monotherapy or dual oral therapy or even uh triple therapy, uh, the treatment is really guided by risk. And we now take patients up to quadruple therapy for patients not reaching low risk status, and that's consistent with the WSPH consensus document. So that all, uh, thank you for your attention. And I'll hand over to my colleague, Doctor Chin to take you through myths 3 and 4 of this program.