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 provide comparable LDL-C reduction. 1, 2
Standard Dosing for Most Indications
The recommended dose is 140 mg subcutaneously every 2 weeks or 420 mg subcutaneously once monthly for adults with established ASCVD, primary hypercholesterolemia, or HeFH 1, 2
Both dosing regimens achieve robust LDL-C reduction when added to maximally tolerated statin therapy: 64% reduction with the every-2-week regimen and 58% reduction with the monthly regimen 1, 2
The same dosing applies to pediatric patients aged 10 years and older with HeFH 1, 2
Homozygous Familial Hypercholesterolemia (HoFH) Dosing
Start with 420 mg subcutaneously once monthly for patients with HoFH 1, 2
If inadequate LDL-C reduction occurs after 12 weeks of therapy, increase the dose to 420 mg every 2 weeks 1, 2, 3
For patients on LDL apheresis, initiate 420 mg every 2 weeks to align with the apheresis schedule, administering evolocumab after apheresis is complete 1
Administration Technique
Injection sites include the abdomen, thigh, or upper arm—rotate sites with each injection 1, 2
For the 420 mg dose, either use the prefilled single-dose on-body infuser OR give three consecutive 140 mg injections within 30 minutes at different injection sites 1, 2
The subcutaneous administration can be performed at home, providing convenience for patients 1
Clinical Efficacy Context
Evolocumab reduces LDL-C to a median of 30 mg/dL from a baseline of 92 mg/dL at 48 weeks 4
In the FOURIER trial of 27,564 patients with prior MI, stroke, or PAD, evolocumab reduced 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, 2, 4
Important Safety Considerations
Contraindicated in patients with a history of hypersensitivity to evolocumab 1, 2
If a serious hypersensitivity reaction occurs, discontinue therapy immediately, treat according to standard of care, and monitor until symptoms resolve 1
Advise latex-sensitive patients that the needle covers contain latex 1, 2
Common adverse effects include nasopharyngitis, upper respiratory tract infection, influenza, back pain, and injection site reactions 1, 2
No evidence of increased cognitive adverse effects was observed in the FOURIER or EBBINGHAUS trials 1, 2
Key Clinical Pitfall
- One case report documented severe worsening of myasthenia gravis after evolocumab administration 5—exercise caution in patients with pre-existing neuromuscular autoimmune disorders, though this represents a single case report and should not alter standard dosing recommendations for the general population