Can I switch a patient from Repatha (evolocumab) 140mg every 2 weeks to a different dose, and if so, what is the alternative dose?

Switching Repatha (Evolocumab) Dosing Regimen

Yes, you can switch your patient from Repatha 140 mg every 2 weeks to 420 mg once monthly, as these are FDA-approved equivalent dosing regimens with similar efficacy. 1

Approved Dosing Options for Repatha

Repatha (evolocumab) has two FDA-approved dosing regimens for adults with established cardiovascular disease or primary hyperlipidemia:

• 140 mg subcutaneously every 2 weeks
• 420 mg subcutaneously once monthly 1, 2

These dosing options are considered therapeutically equivalent, with the 140 mg every 2 weeks dose reducing LDL-C by approximately 64% and the 420 mg monthly dose reducing LDL-C by approximately 58% when added to statin therapy. 2

How to Switch Dosing Regimens

When switching between dosing regimens:

• Administer the first dose of the new regimen (420 mg monthly) on the next scheduled date of the prior regimen (when the next 140 mg dose would have been due) 1
• No dose titration is required when switching between these standard dosing options 2
• The 420 mg dose can be administered using the prefilled single-dose on-body infuser or by administering three 140 mg injections consecutively within 30 minutes 2

Monitoring After Switching

• The LDL-lowering effect of Repatha may be measured as early as 4 weeks after initiation or changing dosing regimens 1
• When monitoring LDL-C for patients receiving Repatha 420 mg once monthly, be aware that LDL-C can vary during the dosing interval in some patients 1
• For patients on the monthly regimen, it's recommended to measure LDL-C just prior to the next scheduled dose to accurately assess the medication's effect 1

Special Considerations

• If a monthly dose is missed by more than 7 days, instruct the patient to administer the dose and start a new schedule based on this date 1
• Prior authorization processes may need to be resubmitted when changing dosing regimens, which could be a factor in the prior authorization denial you mentioned 2

Caveat

For patients with homozygous familial hypercholesterolemia (HoFH), different dosing considerations apply. The initial recommended dosage is 420 mg once monthly, which can be increased to 420 mg every 2 weeks if a clinically meaningful response is not achieved in 12 weeks. 1 If your patient has HoFH, this different dosing schedule would need to be considered.

The monthly dosing regimen may improve adherence for some patients compared to biweekly injections, potentially leading to better outcomes in terms of morbidity and mortality reduction.