Repatha (Evolocumab) Dosing
For adults with ASCVD, primary hypercholesterolemia, or heterozygous familial hypercholesterolemia (HeFH), administer 140 mg subcutaneously every 2 weeks OR 420 mg subcutaneously once monthly—both regimens are equally effective. 1
Standard Dosing by Indication
Primary Hypercholesterolemia, ASCVD, and HeFH
- 140 mg subcutaneously every 2 weeks OR 420 mg subcutaneously once monthly 1
- Both dosing schedules provide comparable LDL-C reduction (64% vs 58% respectively when added to maximally tolerated statin therapy), so choose based on patient preference for injection frequency 1
- This dosing applies to adults and pediatric patients ≥10 years of age with HeFH 1
Homozygous Familial Hypercholesterolemia (HoFH)
- Start with 420 mg subcutaneously once monthly 1
- If inadequate LDL-C reduction after 12 weeks, escalate to 420 mg every 2 weeks 1, 2
- This dose escalation strategy is critical for HoFH patients who often have more resistant hypercholesterolemia 3
- In clinical studies, patients with HoFH who were up-titrated improved their mean LDL-C reduction from -19.6% at week 12 to -29.7% after 12 weeks of the higher dose 3
Administration Technique
Injection Sites and Method
- Administer in the thigh, abdomen, or upper arm, rotating injection sites with each dose 1
- For the 420 mg monthly dose, use either the prefilled single-dose on-body infuser OR give 3 consecutive 140 mg injections within 30 minutes at different injection sites 1
Important Safety Considerations
- Contraindicated in patients with a history of hypersensitivity to evolocumab 1
- Warn latex-sensitive patients that needle covers contain latex 1
- Common adverse effects include nasopharyngitis, upper respiratory tract infection, influenza, back pain, and injection site reactions 1
Clinical Context and Efficacy
LDL-C Reduction Magnitude
- Evolocumab reduces LDL-C by approximately 59-64% when added to maximally tolerated statin therapy 2
- In the FOURIER trial, evolocumab reduced LDL-C by 59% to a median value of 30 mg/dL at 48 weeks from a baseline median of 92 mg/dL 2, 4
Cardiovascular Outcomes
- Evolocumab significantly reduces the composite endpoint of CV death, MI, stroke, revascularization, or hospitalization for unstable angina (HR 0.85; 95% CI 0.79-0.92; P<0.001) 1, 4
- No evidence of increased cognitive adverse effects in major trials 1
Special Populations
- For patients on chronic lipoprotein apheresis with pre-apheresis LDL-C ≤4.9 mmol/L (190 mg/dL), evolocumab 140 mg every 2 weeks may eliminate the need for apheresis in the majority of patients 5
- Long-term safety data extending to a median of 4.1 years demonstrates sustained efficacy and tolerability 3