Can Repatha (evolocumab) cause muscle weakness or foot pain?

Repatha (Evolocumab) and Muscle-Related Side Effects

Repatha (evolocumab) can cause muscle pain and weakness in some patients, with myalgia reported in 4% of patients in clinical trials, though these effects are generally less common and less severe than those associated with statins. 1

Muscle-Related Side Effects of Repatha

Documented Adverse Effects

• The FDA label for Repatha reports muscle-related adverse reactions including:
  • Myalgia (muscle pain) in 4.0% of patients (vs 3.0% with placebo) 1
  • Muscle spasms in 1.3% of patients (vs 1.2% with placebo) 1
  • Musculoskeletal pain in 3.3% of patients 1

Severity and Frequency

• Most muscle-related symptoms with Repatha are mild to moderate in severity
• Myalgia led to discontinuation of treatment in only 0.3% of patients in clinical trials 1
• These rates are significantly lower than those typically seen with statin therapy

Management of Muscle-Related Symptoms

For Mild Muscle Pain

• Continue Repatha therapy
• Consider acetaminophen or NSAIDs for symptom relief if no contraindications exist
• Monitor symptoms for progression 2

For Moderate Muscle Pain or Mildly Elevated CK

• Consider temporary interruption of Repatha
• Assess for other contributing factors (exercise, trauma, other medications)
• Rule out other causes of myalgia
• Consider rechallenge after symptoms resolve 2

For Severe Muscle Pain or Significantly Elevated CK

• Discontinue Repatha
• Consider referral to rheumatology or neurology
• Evaluate for alternative lipid-lowering strategies 2

Distinguishing from Statin-Induced Myopathy

This is particularly important since:

• Many patients taking Repatha are also on statin therapy
• Statin-induced myopathy is more common and well-documented
• Determining which medication is causing symptoms is crucial in patients on both therapies 2

Key Considerations

• Timing: Did symptoms begin after adding Repatha to existing statin therapy?
• Pattern: Statin myopathy typically affects proximal muscles symmetrically
• CK levels: Typically higher with statin-induced myopathy than with Repatha alone

Foot Pain Specifically

The available evidence does not specifically identify foot pain as a common adverse effect of Repatha. The FDA label and clinical trials do not highlight foot pain as a specific concern with evolocumab therapy 1. While general musculoskeletal pain is reported, there is no specific mention of foot pain as a distinct adverse effect.

Prevention and Monitoring

• Baseline assessment of muscle symptoms before starting therapy
• Patient education about potential symptoms to report
• Regular follow-up to assess for development of muscle symptoms
• Consider CK measurement in symptomatic patients

Special Considerations

Concomitant Statin Therapy

• Patients taking both statins and Repatha may have an increased risk of muscle symptoms
• If muscle symptoms develop in patients on combination therapy, consider a statin holiday to determine if symptoms improve 2

Risk Factors for Muscle Symptoms

• Previous statin-associated muscle symptoms
• Advanced age
• Female sex
• Low body mass index
• Hypothyroidism
• Vitamin D deficiency

In conclusion, while Repatha can cause muscle pain and weakness in some patients, these effects are generally less common and less severe than those associated with statins. Careful monitoring and appropriate management strategies can help patients continue this effective lipid-lowering therapy in most cases.