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Evolocumab

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Evolocumab, Repatha

  • See Also
  1. PCSK9 Inhibitor
  2. AntiHyperlipidemic
  3. Hyperlipidemia Management
  4. Alirocumab
  5. Inclisiran (Leqvio)
  • Mechanism
  1. See PCSK9 Inhibitor
  2. Monoclonal Antibody (PCSK9 Inhibitor)
  • Indications
  1. Severe Familial Hypercholesterolemia (e.g. LDL Cholesterol >190 mg/dl)
  • Dosing
  • Adults
  1. May be used in age 13 to 17 years (but not FDA approved in this age group)
  2. Store in refrigerator at 36 to 46 degrees
    1. May also store in original carton up to 30 days at room Temperature <77 F
  3. Administer subcutaneously in the Abdomen, back of the upper arm or the thigh
    1. Administration of full dose may require 15 to 20 seconds
  4. Evolocumab
    1. Every 2 weeks (Sureclick syringe): 140 mg SC
    2. Monthly (Pushtronex infusion device): 420 mg SC
  • Efficacy
  1. See PCSK9 Inhibitor
  2. Lower LDL Cholesterol 42 to 65% with or without a Statin
  3. Evolocumab added to Statin for 2 years prevents one more CV event per 74 treated ($2,000,000 per CV event prevented)
    1. Alkhalil (2017) JAMA 317(16):1690-1691 +PMID: 28444271 [PubMed]
  4. Reanalysis of FOURIER Trial data demonstrated a slightly higher cardiovascular mortality with Repatha
    1. Erviti (2022) BMJ Open 12(12): e060172 [PubMed]
  • Disadvantages
  1. See PCSK9 Inhibitor
  2. Costs $450 per 2 weeks (>$10,000 per year) in 2022
  • Safety
  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  • Reources
  1. Evolocumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=709338ae-ab8f-44a9-b7d5-abaabec3493a
  • References
  1. (2015) Presc Lett 22(9): 50-1
  2. (2022) Non-StatinLipid Lowering Agents, Presc Lett, #380202
  3. (2022) Med Lett Drug Ther 64(1659): 145-52
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  5. Robinson (2015) N Engl J Med 372(16):1489-99 +PMID:25773378 [PubMed]
  6. Stroes (2014) J Am Coll Cardiol 63(23):2541-8 [PubMed]