Praluent Equivalent Dosing for Repatha 140 mg Every 2 Weeks
The equivalent Praluent (alirocumab) dose for Repatha (evolocumab) 140 mg subcutaneously every 2 weeks is Praluent 75 mg subcutaneously every 2 weeks, with potential dose adjustment to 150 mg every 2 weeks if additional LDL-C lowering is needed. 1, 2
Dosing Equivalence
Both PCSK9 inhibitors are FDA-approved for the same indications and administered via subcutaneous injection every 2 weeks, making direct conversion straightforward 1:
- Repatha 140 mg every 2 weeks → Praluent 75 mg every 2 weeks (starting dose)
- If more LDL-C reduction is needed after initiation, Praluent can be increased to 150 mg every 2 weeks 1, 2
LDL-C Reduction Efficacy
The two agents demonstrate comparable LDL-C lowering when added to maximally tolerated statin therapy 1:
- Evolocumab 140 mg every 2 weeks: 64% additional LDL-C reduction 1
- Alirocumab 75 mg every 2 weeks: 45% additional LDL-C reduction 1
- Alirocumab 150 mg every 2 weeks: 58% additional LDL-C reduction 1
The starting dose of Praluent 75 mg provides slightly less LDL-C reduction than Repatha 140 mg, but the 150 mg dose achieves similar efficacy to evolocumab's standard regimen 1.
Alternative Monthly Dosing Option
If the patient prefers less frequent administration, Praluent offers a monthly alternative 1, 2:
- Praluent 300 mg subcutaneously every 4 weeks (administered as two consecutive 150 mg injections at different sites) 1, 2
- This compares to Repatha's monthly option of 420 mg every 4 weeks 1
Cardiovascular Outcomes Evidence
Both agents have demonstrated cardiovascular benefit in high-risk populations 1, 2:
- Alirocumab (ODYSSEY OUTCOMES): Reduced the composite endpoint of CHD death, MI, ischemic stroke, or hospitalization for unstable angina in post-ACS patients (HR 0.85,95% CI 0.78-0.93, p=0.0003) 2
- Evolocumab (FOURIER): Reduced CV death, MI, stroke, revascularization, or hospitalization for unstable angina by 15% (p<0.001) 1, 3
Safety Profile
Both medications share similar safety profiles with no clinically significant drug-drug interactions 1:
- Common adverse effects include nasopharyngitis, injection site reactions, influenza, and upper respiratory tract infections 1
- No evidence of increased cognitive adverse effects with either agent 1
- The only contraindication for both is hypersensitivity to the medication 1, 2
Practical Prescribing Considerations
Start with Praluent 75 mg every 2 weeks and monitor LDL-C response at 2-3 months 2. If the patient requires more aggressive LDL-C lowering (similar to what Repatha 140 mg would have provided), increase to 150 mg every 2 weeks 1, 2.
The dose titration strategy mirrors the approach used in the ODYSSEY OUTCOMES trial, where approximately 28% of patients required dose adjustment to 150 mg every 2 weeks 2.
Important caveat: Praluent may also face prior authorization challenges, as both PCSK9 inhibitors have burdensome authorization processes and high costs 1. Ensure documentation includes maximally tolerated statin therapy, inadequate LDL-C control, and appropriate cardiovascular risk factors or familial hypercholesterolemia diagnosis 1, 2.