What is the use of Repatha (Evolocumab)?

From the Guidelines

Repatha (evolocumab) is a prescription medication used to lower LDL cholesterol levels in patients with high cholesterol, particularly those with familial hypercholesterolemia or established cardiovascular disease, and is typically administered as a subcutaneous injection of 140 mg every two weeks or 420 mg once monthly, as recommended by the most recent guidelines 1. The use of Repatha (evolocumab) is supported by several studies, including the FOURIER trial, which demonstrated a 15% relative risk reduction in cardiovascular events in patients with established cardiovascular disease who received evolocumab in addition to statin therapy 1. The medication works by blocking PCSK9, a protein that prevents the liver from removing LDL cholesterol from the blood, resulting in significantly reduced LDL levels. Some key points to consider when prescribing Repatha (evolocumab) include:

• The medication is usually prescribed when statins alone are insufficient or not tolerated
• Common side effects include injection site reactions, upper respiratory infections, and flu-like symptoms
• Patients should store Repatha in the refrigerator but allow it to warm to room temperature for 30 minutes before injection
• It's essential to continue any prescribed diet and exercise program while taking Repatha, as it works best as part of a comprehensive cholesterol management plan
• Regular blood tests will be needed to monitor cholesterol levels and adjust treatment as necessary The most recent guidelines recommend the use of Repatha (evolocumab) in patients with high cholesterol, particularly those with familial hypercholesterolemia or established cardiovascular disease, as an adjunct to diet and statin therapy 1.

From the FDA Drug Label

REPATHA is a PCSK9 (proprotein convertase subtilisin kexin type 9) inhibitor indicated: To reduce the risk of major adverse cardiovascular (CV) events (CV death, myocardial infarction, stroke, unstable angina requiring hospitalization, or coronary revascularization) in adults with established cardiovascular disease as an adjunct to diet, alone or in combination with other low-density lipoprotein cholesterol (LDL-C)-lowering therapies, in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH), to reduce LDL-C as an adjunct to diet and other LDL-C-lowering therapies in pediatric patients aged 10 years and older with HeFH, to reduce LDL-C as an adjunct to other LDL-C-lowering therapies in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia (HoFH), to reduce LDL-C

The use of Repatha (Evolocumab) is to:

• Reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease
• Reduce LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH)
• Reduce LDL-C in pediatric patients aged 10 years and older with HeFH
• Reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia (HoFH) 2

From the Research

Use of Repatha (Evolocumab)

• Repatha (Evolocumab) is a monoclonal antibody that targets proprotein convertase subtilisin/kexin type 9 (PCSK9) to reduce low-density lipoprotein cholesterol (LDL-C) levels 3, 4, 5.
• It is administered subcutaneously at a dosage of 140 mg every 2 weeks or 420 mg once monthly 3.
• Evolocumab is used to treat primary hypercholesterolemia or mixed dyslipidemia, and homozygous familial hypercholesterolemia, particularly in patients who are unable to reach LDL-C goals despite treatment with statins with or without other lipid-lowering therapies, and in patients who do not tolerate or are not able to receive statins 3, 4, 5.
• It has been shown to significantly reduce the incidence of major cardiovascular adverse events (-15%, P <0.001) in patients with atherosclerotic cardiovascular disease and residual hypercholesterolaemia despite statin therapy 4.
• Evolocumab can further lower LDL-cholesterol levels by about 60% in patients at high risk for atherosclerotic cardiovascular disease already taking maximal statin therapy 6.

Patient Groups

• Evolocumab is effective in patients with:
  • Primary hypercholesterolemia or mixed dyslipidemia 3
  • Homozygous familial hypercholesterolemia 3, 4
  • Heterozygous familial hypercholesterolemia 3
  • Statin intolerance 7
• It can be used as monotherapy or in combination with statin therapy 3, 7.

Efficacy and Safety

• Evolocumab has been shown to be well tolerated and effective in reducing LDL-C levels in various patient groups 3, 4, 5.
• The safety profile of evolocumab is excellent, even in patients with very low LDL-C levels 4.