Does Repatha (Evolocumab) cause arthralgia (joint pain)?

From the Guidelines

Repatha (evolocumab) may cause joint pain in some patients, but this side effect is not well-documented in the provided evidence. The studies mentioned, such as the FOURIER trial 1, primarily focus on the efficacy of PCSK9 inhibitors like evolocumab in reducing LDL cholesterol levels and cardiovascular events, rather than exploring specific side effects like joint pain.

Some key points to consider:

• The FOURIER trial 1 demonstrated a significant reduction in LDL cholesterol levels and cardiovascular events with evolocumab therapy, but did not specifically report on joint pain as a side effect.
• Other studies, such as the ODYSSEY OUTCOMES trial 1, also investigated the effects of PCSK9 inhibitors on cardiovascular outcomes, but did not provide detailed information on joint pain.
• The mechanism by which Repatha might cause joint pain is not fully understood, but could potentially relate to its effects on lipid metabolism or immune responses in some individuals.

If you experience joint pain while taking Repatha, it is essential to discuss this with your healthcare provider to determine the cause and appropriate course of action. They may recommend continuing the medication with pain management strategies or exploring alternative treatment options. It is crucial to weigh the potential benefits of Repatha in reducing cardiovascular risk against the potential side effects, including joint pain, and make an informed decision under the guidance of a healthcare professional.

From the FDA Drug Label

Adverse reactions reported in at least 3% of REPATHA-treated patients, and more frequently than in placebo-treated patients are shown in Table 1. ... Back pain5.66.2 ... Myalgia3.04.0 Musculoskeletal pain3.03.3

Adverse reactions reported in at least 1% of REPATHA-treated patients, and more frequently than in placebo-treated patients, are shown in Table 2. ... Back pain2.22.3 Arthralgia1.61.8

Joint pain is reported as arthralgia and back pain in the drug label.

• Arthralgia occurred in 1.6% of placebo-treated patients and 1.8% of REPATHA-treated patients.
• Back pain occurred in 5.6% of placebo-treated patients and 6.2% of REPATHA-treated patients in one trial, and 2.2% of placebo-treated patients and 2.3% of REPATHA-treated patients in another trial. Based on the information provided in the drug label, Repatha may cause joint pain, as evidenced by the reported adverse reactions of arthralgia and back pain 2.

From the Research

Repatha and Joint Pain

• There is no direct evidence in the provided studies that Repatha (evolocumab) causes joint pain as a common side effect.
• The studies primarily focus on the efficacy and safety of evolocumab in lowering LDL cholesterol levels and reducing cardiovascular events 3, 4, 5, 6, 7.
• Adverse events reported in the studies include injection-site reactions, which were more common with evolocumab than with placebo 4, 5, but joint pain is not specifically mentioned.
• The studies suggest that evolocumab is generally well-tolerated, with no significant difference in adverse events between the evolocumab and placebo groups, except for injection-site reactions 4, 5, 7.