What is the recommended dosing regimen when switching from Repatha (evolocumab) to Praluent (alirocumab)?

Switching from Repatha (evolocumab) to Praluent (alirocumab): Dosing Recommendations

When switching from Repatha (evolocumab) to Praluent (alirocumab), initiate Praluent at 75 mg subcutaneously every 2 weeks, with option to increase to 150 mg every 2 weeks if additional LDL-C reduction is needed, or alternatively start with 300 mg every 4 weeks (administered as two 150-mg injections at different injection sites). 1

Dosing Considerations Based on Prior Repatha Regimen

For patients previously on Repatha 140 mg every 2 weeks:

• Start Praluent at 75 mg subcutaneously every 2 weeks
• This provides approximately 45% LDL-C reduction compared to 64% with Repatha 140 mg 1
• Monitor LDL-C after 4-8 weeks to assess response

For patients previously on Repatha 420 mg monthly:

• Start Praluent at 300 mg subcutaneously every 4 weeks (administered as two 150-mg injections)
• This provides similar dosing frequency with approximately 58% LDL-C reduction compared to 58% with monthly Repatha 1

For patients with HoFH previously on Repatha 420 mg every 2 weeks:

• Start Praluent at 150 mg subcutaneously every 2 weeks 1
• This is the recommended dose for adults with HoFH

Efficacy Comparison and Monitoring

• Praluent 75 mg every 2 weeks reduces LDL-C by approximately 45% compared to 64% with Repatha 140 mg every 2 weeks 1
• Praluent 150 mg every 2 weeks reduces LDL-C by approximately 58% 1
• Monitor LDL-C levels 4-8 weeks after switching to assess response and determine if dose adjustment is needed

Administration Instructions

• Administer Praluent subcutaneously in the thigh, abdomen, or upper arm 1
• For the 300 mg dose, administer two 150-mg injections consecutively at two different injection sites 1
• Allow Praluent to warm to room temperature for 30-40 minutes before injection

Special Considerations

For patients with cardiovascular disease:

• Both medications have demonstrated cardiovascular outcome benefits, with Praluent showing reduction in the primary endpoint of CHD death, MI, ischemic stroke, or hospitalization for unstable angina in the ODYSSEY Outcomes trial 1

For patients with HeFH:

• Both medications are effective; consider starting with Praluent 75 mg every 2 weeks with option to increase to 150 mg if needed 1

For patients with HoFH:

• Use Praluent 150 mg every 2 weeks 1

Safety Considerations

• Both medications have similar safety profiles with comparable adverse effects:

  • Injection site reactions
  • Nasopharyngitis
  • Upper respiratory tract infections
  • No evidence of cognitive adverse effects with either medication 1

• No washout period is required when switching between these PCSK9 inhibitors due to similar mechanisms of action

Common Pitfalls to Avoid

• Failure to adjust dose based on prior Repatha regimen and LDL-C response
• Not monitoring LDL-C levels after switching (should be checked at 4-8 weeks)
• Overlooking the need for two separate injections when administering the 300 mg dose of Praluent
• Not considering patient-specific factors such as HoFH status which may require specific dosing

Following these recommendations will help ensure a smooth transition from Repatha to Praluent while maintaining effective LDL-C control for optimal cardiovascular risk reduction.