From the Guidelines
Repatha (evolocumab) is unlikely to significantly affect liver enzymes in most patients, as clinical trials have shown that it does not commonly cause meaningful changes in liver function tests 1. When considering the potential impact of Repatha on liver enzymes, it's essential to look at the available evidence from clinical trials. The FOURIER study, which investigated the efficacy and safety of evolocumab, found that injection site reactions were more frequent with evolocumab, but there was no significant difference in liver function test abnormalities compared to the placebo group 1. Some key points to consider when evaluating the potential liver effects of Repatha include:
- The mechanism of action of Repatha, which involves inhibiting PCSK9, a protein that regulates LDL receptor recycling, is different from statins, which can more commonly cause liver enzyme elevations 1.
- Clinical trials have shown that Repatha can be effective in reducing LDL-C levels without significantly affecting liver function tests 1.
- Patients with pre-existing liver disease should be monitored more closely while taking Repatha, and regular liver function testing is generally recommended when starting Repatha and periodically thereafter, especially for patients with liver concerns or those taking other medications that affect the liver.
- The available evidence suggests that Repatha is generally well-tolerated, with no significant increase in adverse effects, including liver function test abnormalities, compared to placebo 1.
From the Research
Effect of Repatha on Liver Enzymes
- The provided studies do not directly address the effect of Repatha (evolocumab) on liver enzymes 2, 3, 4, 5, 6.
- However, it is known that Repatha works by inhibiting the proprotein convertase subtilisin/kexin type 9 (PCSK9) protein, which is involved in the degradation of low-density lipoprotein receptors (LDL-R) in the liver 2, 3, 4.
- The studies focus on the efficacy and safety of Repatha in reducing low-density lipoprotein cholesterol (LDL-C) levels in patients with hypercholesterolemia, with no mention of its impact on liver enzymes 2, 3, 4, 5, 6.
- Further research is needed to determine the effect of Repatha on liver enzymes, as the current evidence does not provide a clear answer to this question 2, 3, 4, 5, 6.
Safety and Tolerability of Repatha
- The studies report that Repatha has a good safety profile, with few adverse events reported in clinical trials 2, 3, 4, 5, 6.
- Common adverse events associated with Repatha include back pain, arthralgia, headache, muscle spasms, and pain in extremity, but these are generally mild and infrequent 5, 6.
- The safety and tolerability of Repatha have been evaluated in various clinical trials, but the effect on liver enzymes remains unclear 2, 3, 4, 5, 6.