Repatha (Evolocumab) Dosing
The recommended dose of Repatha is 140 mg subcutaneously every 2 weeks OR 420 mg subcutaneously once monthly for most indications, with both regimens providing equivalent LDL-C reduction. 1
Standard Dosing by Indication
Primary Hypercholesterolemia, ASCVD, and Heterozygous Familial Hypercholesterolemia (HeFH)
Administer either 140 mg subcutaneously every 2 weeks or 420 mg subcutaneously once monthly for adults with atherosclerotic cardiovascular disease, primary hypercholesterolemia, or heterozygous familial hypercholesterolemia 1
Both dosing regimens are therapeutically equivalent, producing 64% and 58% LDL-C reduction respectively when added to maximally tolerated statin therapy 1
For pediatric patients aged 10 years and older with HeFH, use the same adult dosing: 140 mg every 2 weeks or 420 mg monthly 1
Homozygous Familial Hypercholesterolemia (HoFH)
Start with 420 mg subcutaneously once monthly as the initial dose 1
If LDL-C reduction is inadequate after 12 weeks, escalate to 420 mg every 2 weeks 1, 2
This dose escalation strategy is critical for HoFH patients who often have severely impaired LDL receptor function and require more aggressive PCSK9 inhibition 2
Administration Technique
For the 420 mg monthly 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
Acceptable injection sites include the thigh, abdomen, or upper arm 1
Rotate injection sites with each administration to minimize local reactions 1
Expected Clinical Outcomes
Evolocumab reduces LDL-C by approximately 59-64% when added to maximally tolerated statin therapy, achieving median LDL-C levels of 30 mg/dL from baseline values around 92 mg/dL 2, 3
This magnitude of LDL-C reduction translates to a 15% reduction in the composite endpoint of cardiovascular death, MI, stroke, revascularization, or hospitalization for unstable angina (HR 0.85; 95% CI 0.79-0.92) 1
Safety Considerations and Contraindications
Evolocumab is contraindicated in patients with a history of hypersensitivity to evolocumab 1
Common adverse effects include nasopharyngitis, upper respiratory tract infection, influenza, back pain, and injection site reactions 1
No evidence of increased cognitive adverse effects has been demonstrated in major trials 1
The needle covers contain latex—avoid in latex-sensitive patients or counsel appropriately 1