Pros and Cons of Repatha (Evolocumab)

Repatha is a cholesterol-lowering medicine it reduces LDL cholesterol in patients with high-risk conditions such as familial hypercholesterolemia or cardiovascular complications. In this article, we will discuss the pros and cons of Repatha and examine the clinical evidence surrounding its use. We will also explore the potential side effects and risks associated with the medication.

Repatha, also known as evolocumab,  is classified as a PCSK9 inhibitor, which means that it works by blocking a protein that prevents the liver from removing LDL cholesterol from the bloodstream.

Repatha is given as a subcutaneous injection and is used in conjunction with diet and exercise to reduce LDL cholesterol levels in the blood and hence lower the risks of atherosclerotic cardiovascular events.

Pros of Repatha

Effective at reducing LDL cholesterol levels

Repatha is one of the highly potent cholesterol-lowering drugs. It is more potent than conventional statins and may be used by individuals who fail to achieve their target LDL levels despite taking a high-potency statin.

In clinical trials, patients who received Repatha had a mean reduction in LDL cholesterol levels of 59% compared to placebo.

Additionally, when given in combination with a statin, the mean LDL cholesterol was lowered by 66%.

May reduce the risk of cardiovascular events

Because Repatha is one of the most potent LDL-cholesterol-lowering drugs, it reduces the risks of atherosclerotic cardiovascular events such as stroke and myocardial infarction.

In the FOURIER trial, Repatha resulted in a 15% reduction in the risks of cardiovascular events compared to the placebo.

Cardiovascular risk reduction was seen in patients who had a history of cardiovascular events as well as those who had not.

Convenient dosing

Repatha is given as a subcutaneous injection and is typically administered once every two weeks or once every four weeks.

This dosing schedule is convenient for patients who may have difficulty adhering to a daily medication regimen.

No significant drug interactions

Repatha has a low potential for drug interactions, which makes it a safe and effective option for patients who are taking other medications.

Repatha can also be used in combination with a statin such as Lipitor and Crestor and other lipid-lowering drugs.

Cons of Repatha

Cost

One of the major drawbacks of Repatha is its cost. The medication is relatively expensive, with an average cost of around $14,500 per year.

This cost can make the medication inaccessible for some patients, particularly those who do not have insurance coverage or whose insurance does not cover the cost of the medication.

In response to concerns about the cost of Repatha, the manufacturer has established a patient assistance program that can help eligible patients access the medication at a reduced cost.

The program offers discounts on the medication and can help patients find financial assistance if they are unable to afford the medication.

However, the cost of Repatha remains a significant barrier for many patients, and some healthcare providers may be hesitant to prescribe the medication due to its high cost.

Injection site reactions

One of the most common side effects that affect up to 7% of the patients using Repatha is Injection site reactions.

Pain, swelling, redness, hives, and induration have all been reported by individuals injecting Repatha.

Potential for allergic reactions

Repatha use has been associated with allergic reactions, apart from injection site reactions. Allergic reactions may be localized or generalized.

Localized allergic reactions include pain, swelling, and hives at the site of injection. Generalized reactions may include urticaria, swelling of the face or throat, difficulty breathing, stridor, and hypotension.

Limited long-term safety data

The long-term safety of Repatha has not been established as it is a relatively new drug. While Repatha has been shown to be safe and effective in clinical trials, it is important to continue monitoring patients who are taking Repatha to ensure that it remains safe and effective over the long term.

Pros and Cons of Repatha:

Repatha Vs Lipitor and Crestor:

Statins are highly potent lipid-lowering drugs. Although they may be less potent than PCSK-9 inhibitors like Repatha in lowering LDL-cholesterol levels, they are superior in terms of reducing cardiovascular mortality.

In a meta-analysis involving 84 randomized controlled trials and a total of 246,706 participants, the efficacy of PCSK9 inhibitors and statins was compared.

The results showed that PCSK9 inhibitors had a probability of 100% in improving lipid outcomes, whereas statins had a 60.6% probability of being the most effective in reducing the risk of cardiovascular (CV) events.

In contrast, PCSK9 inhibitors had a 37.1% probability of being the most effective for reducing CV events, but there was no significant difference between the two medications in this regard.

Statins were found to be more effective than PCSK9 inhibitors and ezetimibe in reducing all-cause and CV death.

Compared to a placebo, statins were associated with lower risks of all-cause and CV death. However, the use of statins was also found to increase the risk of elevated alanine aminotransferase (ALT) and creatine kinase (CK) levels and the incidence of diabetes.

Overall, the study suggests that both PCSK9 inhibitors and statins are effective in improving lipid outcomes and reducing the risk of CV events, but statins may be more effective in reducing all-cause and CV death

 Pros and Cons of Repatha vs Lipitor:

Crestor (Rosuvastatin) is another highly potent statin that has been found to be very effective in lowering LDL cholesterol levels. In addition, it is less likely associated with a muscle injury.

Pros and Cons of Repatha vs Crestor

Clinical evidence for Repatha

Several clinical trials have been conducted to evaluate the safety and efficacy of Repatha. One of the most notable trials is the FOURIER trial, which included more than 27,000 patients who had either had a previous cardiovascular event or were at high risk for a cardiovascular event.

In the FOURIER trial, patients who received Repatha had a 15% lower risk of atherosclerotic cardiovascular events compared to the placebo (9.8% in the PCSK9 group vs 11.3% in the placebo group). Cardiovascular risk reduction was seen in patients who had a history of cardiovascular events as well as those who had not.

In a secondary analysis of the FOURIER Trial, Repatha lowered LDL levels by 67% and 68% in patients without and with metabolic syndrome respectively.

In addition to these large-scale clinical trials, there have been several smaller trials that have evaluated the safety and efficacy of Repatha in specific patient populations.

For example, a trial called DESCARTES evaluated the use of Repatha in patients with familial hypercholesterolemia. In this trial, it was demonstrated that Repatha users had a mean reduction in LDL levels by 61%. Repatha also lowered apo-lipoprotein B levels and triglyceride levels.

Overall, the clinical evidence suggests that Repatha is a highly potent LDL-lowering drug. In addition, it lowers the risks of cardiovascular events.

Clinical evidence for Repatha

Side effects and risks of Repatha

While Repatha is generally well-tolerated and safe to use, its use may be associated with some side effects.

Injection site reactions are among the most common side effects of Repatha. Patients may report redness, pain, swelling, and induration at the injection site.

Although injection-site reactions are usually mild, systemic allergic reactions have also been observed with Repatha.

Systemic allergic reactions may be mild or severe and life-threatening. Systemic allergic reactions may manifest as urticaria (hives), swelling of the face or throat, difficulty breathing, and hypotension.

Because Repatha is a new drug, data regarding its long-term side effects are limited. There is some concern that long-term use of Repatha could lead to an increased risk of neurological events such as cognitive impairment or stroke.

While there is currently no evidence to suggest that Repatha causes these events, it is important to continue monitoring patients who are taking the medication to ensure that it remains safe over the long term.

Conclusion

Repatha is a new drug from the class. PCSK-9 inhibitors. It is a highly potent LDL-cholesterol-lowering drug. In addition, it also lowers the risks of cardiovascular events.

The medication is effective, easy to administer, and can be given with statins with a low potential for drug interactions.

However, Repatha can be expensive, and some patients may experience side effects such as injection site reactions or allergic reactions. Additionally, there are limited long-term safety data available for the medication.

Patients who are considering taking Repatha should discuss the potential benefits and risks of the medication with their healthcare provider.

Patients who are taking Repatha should also continue to monitor their cholesterol levels and overall cardiovascular health to ensure that the medication remains safe and effective over the long term.

Overall, Repatha is an important medication for high-risk patients who are struggling to manage their cholesterol levels.

While the medication has some drawbacks, it has the potential to significantly lower the risk of cardiovascular events and improve patients’ overall health and quality of life.