Short answer: Both are PCSK9 inhibitors injected under the skin at home, and both are approved to lower heart-event risk and LDL cholesterol.12 Praluent starts at 75 mg every 2 weeks or 300 mg every 4 weeks. Repatha is 140 mg every 2 weeks or 420 mg once a month. Each was tested against placebo, never against the other, and neither has a boxed warning.
| Praluent | Repatha | |
|---|---|---|
| Drug | Alirocumab, a PCSK9 inhibitor1 | Evolocumab, a PCSK9 inhibitor2 |
| Approved for | Lower heart-event risk in adults at increased risk; lower LDL in adults, in HeFH from age 8 and in adults with HoFH1 | Lower heart-event risk in adults at increased risk; lower LDL in adults, and in HeFH and HoFH from age 102 |
| Adult doses | 75 mg every 2 weeks or 300 mg every 4 weeks; 150 mg every 2 weeks if LDL lowering is not enough1 | 140 mg every 2 weeks or 420 mg once a month2 |
| Bigger dose given as | 300 mg: two 150 mg injections at two different sites1 | 420 mg: three 140 mg injections within 30 minutes2 |
| Heart outcome trial | ODYSSEY OUTCOMES vs placebo, after a recent heart attack or unstable angina: 9.5% vs 11.1% had a main event1 | FOURIER vs placebo, with heart or blood vessel disease: 9.8% vs 11.3%; VESALIUS-CV vs placebo: 5.5% vs 7.3%2 |
| Missed dose | Within 7 days, inject and keep the schedule; later, every-2-week users wait for the next dose, every-4-week users inject and start a new schedule1 | Within 7 days, inject and keep the schedule; later, every-2-week users wait for the next dose, monthly users inject and start a new schedule2 |
| Common side effects | Injection site reactions 7% vs 5% on placebo; flu 6% vs 5%1 | Common cold symptoms 10.5% vs 9.6%; upper respiratory infection 9.3% vs 6.3% (52-week trial)2 |
| Storage | Fridge; up to 30 days at room temperature up to 77 F1 | Fridge; up to 30 days at 68 F to 77 F2 |
| Boxed warning | None1 | None2 |
ODYSSEY OUTCOMES enrolled 18,924 adults who had a heart attack or unstable angina 4 to 52 weeks earlier, on intensive or maximum-tolerated statins. Over a median 33 months, the main outcome (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.1
FOURIER enrolled 27,564 adults with established heart or blood vessel disease on statins. Over a median 26 months, its main outcome, which also counted procedures to restore blood flow, happened in 9.8% on Repatha vs 11.3% on placebo. VESALIUS-CV enrolled 12,206 high-risk adults who had never had a heart attack or stroke; over a median 55 months, heart disease death, heart attack or ischemic stroke happened in 5.5% vs 7.3%.2 The trials counted different events in different people. These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
In ODYSSEY LONG TERM, Praluent 150 mg every 2 weeks lowered LDL 58% more than placebo at week 24, on top of statins.1 In LAPLACE-2, Repatha lowered LDL 71% (140 mg every 2 weeks) and 63% (420 mg monthly) more than placebo at week 12, on top of statins.2 Both labels also report trials against ezetimibe: Praluent -50% vs -22% at week 12, and Repatha 45% and 41% more than ezetimibe at week 12.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Praluent side effects, Repatha side effects, the Praluent and Repatha dosing schedules, the Praluent and Repatha missed-dose pages, LDL cholesterol, and Leqvio vs Repatha: how do the 6-month shot and the home injection differ?.