Can Repatha Cause Muscle Aches?
Repatha (evolocumab) does not cause muscle aches at rates higher than placebo, making it an excellent alternative for patients who experience muscle symptoms with statins. 1
Evidence from Clinical Trials
The safety profile of PCSK9 inhibitors like Repatha is distinctly different from statins when it comes to muscle-related adverse events:
- Muscle toxicity appears uncommon with evolocumab, with the overall incidence of side effects similar to placebo 1
- Adverse reactions reported with evolocumab include myalgia or muscular pain, but these occur at rates comparable to placebo-treated patients 1
- The most common adverse effects with evolocumab are injection site reactions (pain, erythema, or allergic effects at the injection site), which are usually mild 1
Contrast with Statin-Associated Muscle Symptoms
This is markedly different from statins, where muscle-related complaints are well-documented:
- Statins commonly cause non-specific muscle aches in approximately 5% of patients in placebo-controlled trials, though this rate is similar to placebo 1
- The commonest adverse effects with statins are muscle-related, accounting for up to 72% of all adverse events 1
- Severe myositis with statins (muscle aches with CK >10x upper limit of normal) is rare but can progress to rhabdomyolysis if not recognized 1
Clinical Implications
For patients experiencing muscle symptoms on statins, evolocumab represents a safe alternative that can achieve substantial LDL-C reduction (59-64% reduction when added to maximally tolerated statin therapy) without the muscle toxicity concerns 2:
- Evolocumab can be used in statin-intolerant patients who cannot tolerate statins due to muscle symptoms 3, 4
- The drug maintains excellent safety even at very low LDL-C levels 5
- Long-term safety data (up to 76 weeks) confirms good tolerance without increased muscle-related adverse events 4
Important Caveat
While evolocumab itself does not cause muscle aches, patients may still be taking background statin therapy (as evolocumab is typically added to maximally tolerated statins), so any muscle symptoms should be evaluated in the context of all lipid-lowering medications the patient is receiving 2.