From the Guidelines
The starting dose for Repatha (evolocumab) is 140 mg injected subcutaneously every 2 weeks or alternatively 420 mg once monthly, as recommended by the most recent guidelines 1. This dosing regimen is effective for lowering LDL cholesterol in patients with established atherosclerotic cardiovascular disease or familial hypercholesterolemia who need additional LDL cholesterol lowering beyond what statins can provide. Some key points to consider when prescribing Repatha include:
- The medication should be stored in the refrigerator but can be kept at room temperature for up to 30 days.
- Patients should allow the medication to warm to room temperature for at least 30 minutes before injection.
- Common injection sites include the abdomen, thigh, or upper arm.
- Repatha works by inhibiting PCSK9, a protein that regulates LDL receptor recycling, thereby increasing the number of LDL receptors on liver cells and enhancing clearance of LDL from the bloodstream. According to the 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk 1, and the 2024 recommendations on the optimal use of lipid-lowering therapy in established atherosclerotic cardiovascular disease and following acute coronary syndromes 1, Repatha is a valuable addition to statin therapy for patients who require further LDL cholesterol lowering. The choice of dosing regimen may depend on individual patient factors, such as convenience and tolerability. It is essential to monitor LDL cholesterol levels regularly and adjust the treatment plan as needed to achieve target LDL cholesterol values of < 55 mg/dL (< 1.4 mmol/L) 1.
From the Research
Dosage Information
- The starting dose for Repatha (Evolocumab) is 140 mg administered subcutaneously every 2 weeks or 420 mg once monthly 2, 3, 4.
Administration
Pharmacokinetics and Pharmacodynamics
- The effective half-life of evolocumab is 11-17 days 4.
- Peak reduction of LDL-C occurs approximately 1 week after a subcutaneous dose of 140 mg every 2 weeks and 2 weeks after a subcutaneous dose of 420 mg once monthly 4.
Clinical Efficacy
- Evolocumab reduces LDL-C by approximately 55-75% compared with placebo 4.
- Evolocumab also reduces lipoprotein(a) [Lp(a)] levels and improves those of other lipids in clinical studies 4.
Special Considerations
- No dose adjustment is necessary based on patient-specific factors or concomitant medication use 4.