Back Pain as a Side Effect of Repatha (Evolocumab)
Yes, Repatha (evolocumab) can cause back pain as a documented adverse effect. According to the American College of Cardiology guidelines, back pain is specifically listed among the adverse effects observed in patients with primary hyperlipidemia taking evolocumab 1.
Evidence for Back Pain with Repatha
The FDA drug label for Repatha clearly documents back pain as an adverse reaction:
- In a 52-week controlled trial, back pain occurred in 6.2% of patients receiving Repatha compared to 5.6% of patients receiving placebo 2
- Back pain is specifically listed among the adverse reactions occurring in ≥3% of Repatha-treated patients and more frequently than with placebo 2
Frequency and Context of Back Pain
The occurrence of back pain with Repatha appears to be:
- Relatively common but not severe in most cases
- Listed among the primary adverse effects in patients with hyperlipidemia alongside nasopharyngitis, upper respiratory tract infection, influenza, and injection site reactions 1
- Not typically a reason for discontinuation of therapy (myalgia was more commonly associated with discontinuation at 0.3% vs 0% for placebo) 2
Clinical Implications
When prescribing Repatha, healthcare providers should:
- Inform patients that back pain is a possible side effect
- Monitor for back pain, especially in the first few weeks of treatment
- Distinguish between back pain related to Repatha and other causes of back pain
- Consider that back pain rarely leads to discontinuation of therapy, suggesting it may be manageable in most patients
Other Common Adverse Effects
For context, other common adverse effects of Repatha include:
- Nasopharyngitis (10.5% vs 9.6% for placebo)
- Upper respiratory tract infection (9.3% vs 6.3%)
- Influenza (7.5% vs 6.3%)
- Injection site reactions (5.7% vs 5.0%)
- Cough (4.5% vs 3.6%)
- Myalgia (4.0% vs 3.0%) 2
Management Considerations
If a patient experiences back pain while on Repatha:
- Evaluate the severity and impact on quality of life
- Consider simple analgesics for symptom management if appropriate
- Monitor for improvement or worsening over time
- Weigh the cardiovascular benefits of continued therapy against the discomfort
- Only consider discontinuation if the pain is severe or significantly impacts quality of life
Back pain appears to be a recognized but generally manageable side effect of Repatha that should be discussed with patients but rarely necessitates discontinuation of this effective lipid-lowering therapy.