Short answer: Leqvio (inclisiran) is an siRNA aimed at PCSK9, given by a healthcare professional at the start, at 3 months, then every 6 months.1 Praluent (alirocumab) is a PCSK9 inhibitor injected at home every 2 or 4 weeks.2 Both lower LDL cholesterol; only Praluent's label is approved to lower heart-event risk. Neither label compares the two.
| Leqvio | Praluent | |
|---|---|---|
| Drug | Inclisiran, a small interfering RNA (siRNA) directed to PCSK91 | Alirocumab, a PCSK9 inhibitor2 |
| Approved for | Lower LDL in adults, in HeFH from age 12, and in children 12 and older with HoFH1 | Lower heart-event risk in adults at increased risk; lower LDL in adults, in HeFH from age 8 and in adults with HoFH2 |
| Who gives it | A healthcare professional1 | You or a caregiver at home; children 8 to 11 by a caregiver2 |
| Schedule | 284 mg at the start, at 3 months, then every 6 months1 | 75 mg every 2 weeks or 300 mg every 4 weeks; 150 mg every 2 weeks if needed2 |
| LDL change vs placebo | -52%, -50% and -48% at day 510 (ORION-10, ORION-11, ORION-9)1 | -58% at week 24 on 150 mg every 2 weeks (ODYSSEY LONG TERM)2 |
| Heart outcome trial in the label | None1 | ODYSSEY OUTCOMES: 9.5% vs 11.1% on placebo2 |
| Missed dose | Missed by less than 3 months: give it and keep the schedule; more than 3 months: start a new schedule1 | Within 7 days, inject and keep the schedule; later, depends on the schedule2 |
| Common side effects | Injection site reactions 8% vs 2% on placebo; joint pain 5% vs 4%1 | Injection site reactions 7% vs 5% on placebo; flu 6% vs 5%2 |
| Storage | Room temperature, 68 F to 77 F1 | Fridge; up to 30 days at room temperature up to 77 F2 |
| Boxed warning | None1 | None2 |
Leqvio's three main trials ran 18 months in adults on maximum-tolerated statins. At day 510, LDL fell 52% more than placebo in ORION-10, 50% more in ORION-11 and 48% more in ORION-9 (HeFH). People already taking PCSK9 inhibitors were excluded. The label reports no heart-event trial of Leqvio itself.1
Praluent's ODYSSEY OUTCOMES enrolled 18,924 adults 4 to 52 weeks after a heart attack or unstable angina. Over a median 33 months, heart disease death, non-fatal heart attack, ischemic stroke or unstable angina needing a hospital stay happened in 9.5% on Praluent vs 11.1% on placebo.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Injection site reactions were the most common side effect for both: 8% vs 2% for Leqvio and 7% vs 5% for Praluent. The Leqvio label also says it may harm an unborn baby based on how it works, and to stop it when pregnancy is recognized or weigh ongoing need.12
Which, if either, fits is for your prescriber. More detail: Leqvio side effects, Praluent side effects, the Leqvio and Praluent dosing schedules, the Leqvio and Praluent missed-dose pages, LDL cholesterol, and Praluent vs Repatha: how do the two PCSK9 inhibitors differ?.