Recommended Dosing Regimen for Repatha (Evolocumab)
The recommended dosing for Repatha (evolocumab) is 140 mg subcutaneously every 2 weeks or 420 mg subcutaneously once monthly for adults with ASCVD or primary hypercholesterolemia, while patients with homozygous familial hypercholesterolemia (HoFH) should receive 420 mg monthly with option to increase to 420 mg every 2 weeks if needed. 1
Dosing Based on Patient Population
Adults with ASCVD or Primary Hypercholesterolemia
- 140 mg subcutaneously every 2 weeks OR
- 420 mg subcutaneously once monthly 1
Pediatric Patients (≥10 years) with Heterozygous Familial Hypercholesterolemia (HeFH)
- Same dosing as adults: 140 mg every 2 weeks OR 420 mg monthly 1
Patients with Homozygous Familial Hypercholesterolemia (HoFH)
- Initial dose: 420 mg subcutaneously once monthly
- Can increase to 420 mg every 2 weeks if additional LDL-C reduction is needed after 12 weeks of treatment 1, 2
- In clinical studies, patients with HoFH who were up-titrated from monthly to every 2 weeks dosing showed improved LDL-C reduction from -19.6% at week 12 to -29.7% after the dose increase 2
Patients on LDL Apheresis
- 420 mg subcutaneously every 2 weeks
- Should be administered after apheresis is complete
- Timing should correspond with the apheresis schedule 1
Administration Guidelines
Injection Technique
- Administer subcutaneously into:
- Abdomen
- Thigh
- Upper arm
- Rotate injection sites 1
Administration Options
- Prefilled single-dose on-body infuser OR
- Three consecutive 140-mg injections within 30 minutes (for 420 mg dose) 1
Efficacy and Monitoring
- Repatha reduces LDL-C by 50-65% when added to statins 1, 3
- No specific laboratory monitoring required beyond routine lipid profile assessment
- No requirement for liver function tests, renal function, or complete blood counts 1
- Clinical outcomes data from the FOURIER trial demonstrated a 15% relative risk reduction in composite cardiovascular endpoints (HR 0.85) 1, 4
Safety Considerations
Common Side Effects
Special Precautions
- Patients with latex sensitivity should be advised that some needle covers contain dry natural rubber
- Discontinue therapy if serious hypersensitivity reaction occurs 1
- The medication has demonstrated good tolerability in long-term studies with a median follow-up of 4.1 years 2
Clinical Pearls
- For patients with HoFH, consider dose escalation to every 2 weeks if LDL-C reduction is inadequate after 12 weeks of monthly dosing 1, 2
- Repatha can be safely used in patients with a history of tendinitis, with no known association with tendon disorders 1
- Prior authorization processes may be burdensome, and the high cost may restrict use despite excellent efficacy 1, 5
- Some patients on apheresis may be able to discontinue this procedure after starting Repatha therapy 2