Can Repatha (evolocumab) be taken with a statin (HMG-CoA reductase inhibitor)?

From the Guidelines

Yes, Repatha (evolocumab) can be taken with a statin (HMG-CoA reductase inhibitor) as part of a comprehensive lipid-lowering strategy to reduce the risk of cardiovascular events. According to the most recent guidelines, the combination of a statin and a PCSK9 inhibitor like evolocumab is recommended for patients who require additional cholesterol-lowering effects beyond what statins alone can provide 1. This combination can be particularly effective for patients with very high cholesterol levels, those with familial hypercholesterolemia, or individuals who have had cardiovascular events and need intensive lipid-lowering therapy.

Key Considerations

• The combination of a statin and evolocumab can help achieve target LDL-C values of < 55 mg/dL (< 1.4 mmol/L) 1.
• Evolocumab works differently than statins, helping the liver remove more LDL ("bad") cholesterol from the bloodstream, while statins reduce cholesterol production in the liver.
• The combination can be well-tolerated, with side effects generally similar to those of each medication individually, although muscle pain should be monitored 2, 3.
• Repatha is typically administered as a subcutaneous injection of either 140 mg every two weeks or 420 mg once monthly, while continuing the prescribed statin dose.

Clinical Recommendations

• Patients with established atherosclerotic cardiovascular disease or those who have had acute coronary syndromes should have their LDL-C levels regularly monitored and aim for target values of < 55 mg/dL (< 1.4 mmol/L) 1.
• The addition of evolocumab to a statin and ezetimibe may be considered for patients with severe primary hypercholesterolemia who have an LDL-C ≥ 100 mg/dL despite maximal tolerated statin and ezetimibe therapy 3.
• Always take both medications exactly as prescribed by your doctor and report any unusual side effects promptly.

From the FDA Drug Label

The mean LDL-C at baseline was 184 mg/dL; 17% of patients were on high-intensity statin, 62% on moderate-intensity statin, and 13% on ezetimibe. The mean LDL-C at baseline was 349 mg/dL with all patients on statins (atorvastatin or rosuvastatin) and 92% on ezetimibe Median (Q1, Q3) LDL-C at baseline was 398 (343, 475) mg/dL, and all patients were on statins (atorvastatin or rosuvastatin) and ezetimibe.

Yes, Repatha (evolocumab) can be taken with a statin (HMG-CoA reductase inhibitor) as evidenced by the studies where patients were on statins and received REPATHA, showing reductions in LDL-C levels 4, 5.

• Key points: + Patients in the studies were on statins, such as atorvastatin or rosuvastatin, and received REPATHA. + The combination of REPATHA and statins resulted in significant reductions in LDL-C levels. + There is no direct information in the drug labels suggesting that Repatha cannot be taken with a statin.

From the Research

Repatha (Evolocumab) and Statin Combination

• Repatha (evolocumab) can be taken with a statin (HMG-CoA reductase inhibitor) as evidenced by studies showing its efficacy in reducing low-density lipoprotein cholesterol (LDL-C) levels when added to statin therapy 6, 7.
• The combination of evolocumab and statin has been shown to be effective in patients with primary hypercholesterolemia or mixed dyslipidemia, as well as in patients with heterozygous and homozygous familial hypercholesterolemia 6.
• Evolocumab can further lower LDL-cholesterol levels by about 60% in patients at high risk for atherosclerotic cardiovascular disease already taking maximal statin therapy 7.

Mechanism of Action

• Statins inhibit 3-hydroxyl-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase) to reduce low-density lipoprotein (LDL) by about 20% to 45% 8.
• Evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody, can reduce LDL from baseline by 53% to 56% by regulating the hepatic LDLR degradation pathway 8.
• The combination of statin and evolocumab exerts lipid-lowering effects by regulating different key pathways in lipid metabolism, resulting in improved lipid-lowering effect 8.

Safety and Efficacy

• The safety and efficacy of evolocumab when added to statin therapy have been established, with evolocumab being well tolerated and effective in reducing LDL-C levels 6, 9.
• The combination of statin and evolocumab has not been associated with major safety issues, although injectable PCSK9 inhibitors like evolocumab may be associated with a small increase in injection site reactions 9.