Blood Monitoring When Renewing Praluent (Alirocumab)
No routine blood monitoring is required for Praluent (alirocumab) itself, but lipid panels should be checked to assess treatment response and achievement of LDL-C goals. 1
Primary Monitoring: Lipid Panel
Check a lipid panel (LDL-C, total cholesterol, non-HDL-C, apolipoprotein B) at renewal to assess treatment efficacy and goal achievement. 2, 3
The American College of Cardiology recommends follow-up lipid testing within 4-12 weeks after initiating or changing PCSK9 inhibitor therapy, then at least annually for patients on stable therapy. 2, 3
Target LDL-C goals are <70 mg/dL (<1.8 mmol/L) for very high-risk patients or <100 mg/dL (<2.6 mmol/L) for high-risk patients. 2
Non-HDL-C and apolipoprotein B are also important treatment targets, with goals of <100 mg/dL (or <130 mg/dL for high-risk) and <80 mg/dL respectively. 2, 4
No Hepatic or Muscle Enzyme Monitoring Required
Unlike statins, PCSK9 inhibitors (alirocumab and evolocumab) do not require routine monitoring of hepatic transaminases (ALT/AST) or creatine kinase (CK). 1
The 2022 ACC Expert Consensus states that alirocumab has no warnings or precautions requiring routine laboratory monitoring for hepatotoxicity or myopathy. 1
The FDA label for Praluent does not mandate any baseline or ongoing laboratory monitoring beyond lipid assessment. 5
Clinical Context for Monitoring
If the patient is on concomitant statin therapy, continue monitoring hepatic transaminases and CK according to statin-specific guidelines (typically every 3-4 months in the first year, then every 6 months). 1
When ezetimibe is used in combination with statins, monitor hepatic transaminases before and during treatment based on statin monitoring recommendations. 1
Practical Monitoring Schedule
At renewal (typically every 3-6 months initially): Obtain lipid panel to verify LDL-C reduction and goal achievement. 2, 3
Once stable on therapy: Annual lipid panels are sufficient for ongoing monitoring. 2, 3
Dose adjustment consideration: If LDL-C remains ≥70 mg/dL after 8 weeks on alirocumab 75 mg every 2 weeks, consider up-titration to 150 mg every 2 weeks. 1, 5
Common Pitfalls to Avoid
Do not order routine liver function tests or CK levels for Praluent monitoring—these are unnecessary and not indicated by guidelines or the FDA label. 1, 5
Do not confuse PCSK9 inhibitor monitoring with statin monitoring requirements—they have distinctly different safety profiles. 1
Ensure adequate follow-up of lipid values to verify treatment effectiveness, not just prescription renewal without outcome assessment. 2, 6