Repatha (Evolocumab) Dosing
The recommended dose of Repatha is either 140 mg subcutaneously every 2 weeks OR 420 mg subcutaneously once monthly, with both regimens providing equivalent LDL-cholesterol lowering efficacy. 1
Standard Dosing by Clinical Indication
Adults with ASCVD or Primary Hypercholesterolemia
- Administer 140 mg subcutaneously every 2 weeks OR 420 mg once monthly 2, 1
- Both dosing regimens are interchangeable based on patient preference, providing comparable LDL-C reductions of 64% and 58% respectively when added to maximally tolerated statin therapy 2, 3
- If switching between regimens, administer the first dose of the new regimen on the next scheduled date of the prior regimen 1
Pediatric Patients (≥10 years) with Heterozygous Familial Hypercholesterolemia
- Use the same dosing as adults: 140 mg every 2 weeks OR 420 mg once monthly 2, 1
- Administration sites include abdomen, thigh, or upper arm 3
Homozygous Familial Hypercholesterolemia (HoFH)
- Initial dose: 420 mg once monthly 2, 1
- If inadequate LDL-C reduction after 12 weeks, increase to 420 mg every 2 weeks 2, 3, 1
- For patients on LDL apheresis, may initiate at 420 mg every 2 weeks to correspond with apheresis schedule; administer after apheresis is complete 2, 1
Administration Details
Dose Preparation for 420 mg
- Use the prefilled single-dose on-body infuser OR give 3 consecutive 140 mg injections within 30 minutes at different injection sites 2, 3
- Rotate injection sites among thigh, abdomen, or upper arm 3
Preparation Requirements
- Allow refrigerated Repatha to warm to room temperature for at least 30 minutes before injection 1
- Visually inspect for clarity; solution should be clear to opalescent, colorless to pale yellow 1
- Do not use if cloudy, discolored, or contains particles 1
Missed Dose Management
Within 7 Days of Missed Dose
- Administer the missed dose immediately and resume the original schedule 1
More Than 7 Days After Missed Dose
- For every 2-week dosing: Wait until the next scheduled dose on the original schedule 1
- For monthly dosing: Administer the dose immediately and start a new schedule based on this date 1
Monitoring and Response Assessment
- LDL-C reduction can be measured as early as 4 weeks after initiation 1
- For patients on 420 mg monthly, LDL-C levels can vary during the dosing interval; measure just prior to the next scheduled dose for most accurate assessment 1
- Peak LDL-C reduction occurs approximately 1 week after 140 mg every 2 weeks and 2 weeks after 420 mg monthly at steady state 4
Clinical Efficacy Evidence
- Evolocumab reduced LDL-C by 59% in the FOURIER trial (from median 92 mg/dL to 30 mg/dL) 2
- Demonstrated 15% relative risk reduction in cardiovascular death, MI, stroke, hospitalization for angina, or revascularization (P<0.001) 2
- The 20% reduction in cardiovascular death, MI, or stroke was consistent across subgroups 2
Safety Considerations
Contraindications
Latex Sensitivity
- Advise latex-sensitive patients that needle covers on some presentations contain dry natural rubber (latex derivative) 2, 3, 1
- Consider prescribing a latex-free presentation for latex-sensitive individuals 1
Common Adverse Effects
- Nasopharyngitis, upper respiratory tract infection, influenza, back pain, and injection site reactions in primary hyperlipidemia patients 2, 3
- Diabetes, nasopharyngitis, and upper respiratory tract infection in ASCVD patients 2
- No evidence of increased cognitive adverse effects in FOURIER or EBBINGHAUS trials 2, 3