Definition: A PCSK9 inhibitor is an injected cholesterol medicine that blocks PCSK9, a protein that makes the liver break down its LDL receptors. The Repatha label explains that with PCSK9 blocked, more receptors stay on liver cells to pull LDL cholesterol out of the blood. Praluent and Repatha are monoclonal antibodies; Leqvio is a small interfering RNA (siRNA).
| Label | Type | How often |
|---|---|---|
| Praluent (alirocumab) | Monoclonal antibody that binds PCSK9 | Every 2 weeks or every 4 weeks |
| Repatha (evolocumab) | Monoclonal antibody that binds PCSK9 | Every 2 weeks or once a month |
| Leqvio (inclisiran) | siRNA that stops the liver making PCSK9 | Given in the clinic at the start, at 3 months, then every 6 months |
Praluent and Repatha are also approved to lower the risk of major heart events in adults at higher risk. In the FOURIER outcomes trial, Repatha on top of a statin cut LDL by 59% at 48 weeks, from a median of 92 to 30 mg/dL.
In the Leqvio trials, injection site reactions were 8% vs 2% on placebo. The Repatha label notes that on the monthly dose LDL can vary during the month, so it is measured just before the next dose. Leqvio's label has a 3-month rule for a missed dose.
Schedules range from every 2 weeks to every 6 months, and a 6-month gap is easy to forget. Logging each shot and each LDL result with dates shows whether a lab was drawn at the point in the cycle the label describes.
Read more on Dose Track: Praluent side effects · Repatha side effects · Leqvio side effects · Leqvio vs Repatha