Number Needed to Treat for Repatha (Evolocumab)

Evidence for NNT with Repatha

The American Heart Association recommends that the number needed to treat (NNT) for Repatha (evolocumab) is 67 over 2.2 years to prevent one major cardiovascular event in patients with atherosclerotic cardiovascular disease, based on the FOURIER trial which demonstrated an absolute risk reduction (ARR) of 1.5% for the composite primary endpoint of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization over 2.2 years 1
The FOURIER trial, which evaluated evolocumab in 27,564 patients with atherosclerotic cardiovascular disease on background statin therapy, demonstrated a 20% relative risk reduction (HR: 0.80; 95% CI: 0.73-0.88) with event rates of 5.9% vs. 7.4% (placebo), also yielding an NNT of 67 1

The American College of Cardiology notes that alirocumab (another PCSK9 inhibitor) demonstrated a similar NNT of 63 over 2.8 years in the ODYSSEY OUTCOMES trial 1
Ezetimibe plus simvastatin showed an NNT of 50 over 6 years in the IMPROVE-IT trial for secondary prevention, as reported by the Mayo Clinic Proceedings 2, 3
The NNT for ezetimibe was more favorable in patients with diabetes, with an absolute risk reduction of 5.5% over 7 years (NNT of approximately 18), according to Circulation 4

The 2018 AHA/ACC cholesterol guidelines recognize the role of PCSK9 inhibitors for secondary prevention in high-risk patients not achieving adequate LDL-C lowering with maximally tolerated statin therapy, as stated in Circulation 1, 6
The American College of Cardiology states that evolocumab is FDA-approved to reduce the risk of MI, stroke, and coronary revascularization in adults with established cardiovascular disease, and is administered subcutaneously either as 140 mg every 2 weeks or 420 mg once monthly 5