Repatha (Evolocumab) Dosing Guidelines

Standard Dosing by Indication

• The American College of Cardiology recommends administering 140 mg of evolocumab subcutaneously every 2 weeks or 420 mg subcutaneously once monthly for adults with ASCVD, primary hypercholesterolemia, or heterozygous familial hypercholesterolemia (HeFH) 1, 2
• Both regimens provide comparable LDL-C reduction (64% and 58% respectively when added to maximally tolerated statin therapy) 3
• For pediatric patients (≥10 years) with HeFH, the recommended dose is 140 mg subcutaneously every 2 weeks or 420 mg once monthly, with the same administration sites as adults 2

Homozygous Familial Hypercholesterolemia (HoFH) Treatment

• Initial dosing for HoFH is 420 mg subcutaneously once monthly 1, 4
• If inadequate LDL-C reduction after 12 weeks, the dose can be increased to 420 mg every 2 weeks 1, 4

Administration Details

• The American College of Cardiology recommends administering the 420 mg dose using the prefilled single-dose on-body infuser or giving 3 consecutive 140 mg injections within 30 minutes at different injection sites 1, 6
• Injection sites include the thigh, abdomen, or upper arm, and rotation of injection sites is recommended 1, 2

Clinical Efficacy

• Evolocumab reduces the primary endpoint of CV death, MI, stroke, revascularization, or hospitalization for unstable angina (HR 0.85; 95% CI 0.79-0.92; P<0.001) in the FOURIER trial 4

Safety Considerations

• The American College of Cardiology notes that evolocumab is contraindicated in patients with a history of hypersensitivity to evolocumab 3, 4
• Common adverse effects include nasopharyngitis, upper respiratory tract infection, influenza, back pain, and injection site reactions 3, 4
• There is no evidence of increased cognitive adverse effects in FOURIER or EBBINGHAUS trials 3, 6
• The American College of Cardiology advises latex-sensitive patients that needle covers contain latex 4, 5