What is the recommended dosing for Repatha (evolocumab)?

Recommended Dosing for Repatha (Evolocumab)

For adults with ASCVD or primary hypercholesterolemia (including heterozygous familial hypercholesterolemia), Repatha should be administered as 140 mg subcutaneously every 2 weeks OR 420 mg subcutaneously once monthly. 1, 2

Dosing Based on Patient Population

Standard Dosing

• Adults with ASCVD or primary hypercholesterolemia (including HeFH):
  • 140 mg subcutaneously every 2 weeks OR
  • 420 mg subcutaneously once monthly 1, 2
• Pediatric patients (≥10 years) with HeFH:
  • Same dosing as adults: 140 mg every 2 weeks OR 420 mg monthly 1

Special Populations

• Adults or pediatric patients (≥10 years) with homozygous familial hypercholesterolemia (HoFH):

  • Initial dose: 420 mg subcutaneously once monthly
  • If additional LDL-C reduction needed after 12 weeks: May increase to 420 mg every 2 weeks 1, 2

• Patients on LDL apheresis:

  • Adults or pediatric patients (≥10 years) with HoFH: 420 mg subcutaneously every 2 weeks to correspond with apheresis schedule
  • Administer after apheresis is complete 1
  • Adults with HeFH undergoing apheresis: 150 mg subcutaneously every 2 weeks 1

Administration Instructions

Injection Technique

• Administer subcutaneously into the abdomen, thigh, or upper arm 1, 2
• Rotate injection sites 2
• If refrigerated, allow medication to warm to room temperature:
  • 30 minutes for prefilled autoinjector/syringe
  • 45 minutes for on-body infusor 2

For 420 mg Dosing

• Use the prefilled single-dose on-body infuser OR
• Give 3 consecutive 140-mg injections within 30 minutes 1

Monitoring

• Assess LDL-C when clinically appropriate
• LDL-lowering effect measurable as early as 4 weeks after initiation
• Routine monitoring every 3-6 months or as clinically indicated 2
• No specific laboratory monitoring required beyond routine lipid profile assessment 2

Clinical Efficacy and Safety

• Reduces LDL-C by 50-65% from baseline when added to statins 2, 3
• Demonstrated 15% relative risk reduction in composite cardiovascular endpoints in the FOURIER trial 2, 4
• Common side effects: injection site reactions, nasopharyngitis, upper respiratory tract infection 1, 2

Important Considerations

• Latex warning: Advise latex-sensitive patients that some needle covers contain dry natural rubber 1, 2
• Hypersensitivity reactions: Discontinue therapy if serious reaction occurs 1
• Long-term safety profile is favorable with yearly serious adverse event rates comparable to standard of care 2, 5

Evolocumab has demonstrated consistent efficacy and safety in long-term studies, with sustained LDL-C reduction over a median of 4.1 years in patients with familial hypercholesterolemia 5.