Cardiovascular Medicine Book


PCSK9 Inhibitor

Aka: PCSK9 Inhibitor, Praluent, Alirocumab, Repatha, Evolocumab
  1. See Also
    1. AntiHyperlipidemic
    2. Hyperlipidemia Management
    3. Inclisiran (Leqvio)
  2. Mechanism
    1. Monoclonal antibodies (PCSK9 Inhibitor)
  3. Indications
    1. Severe familial Hypercholesterolemia (e.g. LDL Cholesterol >190 mg/dl)
  4. Background
    1. Available in U.S. as of 2015
  5. Preparations
    1. Praluent (Alirocumab)
    2. Repatha (Evolocumab)
  6. Efficacy
    1. See disadvantages below
    2. Lower LDL Cholesterol up to 60%
    3. Repatha added to Statin for 2 years prevents one more CV event per 74 treated ($2,000,000 per CV event prevented)
      1. Alkhalil (2017) JAMA 317(16):1690-1691 +PMID: 28444271 [PubMed]
  7. Disadvantages
    1. Very expensive agents ($14,000 per year)
      1. Contrast with Statins which cost $250 per year
      2. Statin alone for 5 years prevents one more fatal CV event per 39 treated ($48,000 per fatal CV event prevented)
    2. New, with only short-term data
      1. Unknown longterm safety
      2. Unknown mortality reduction (contrast with proven Statin efficacy)
  8. References
    1. (2015) Presc Lett 22(9): 50-1
    2. Robinson (2015) N Engl J Med 372(16):1489-99 +PMID:25773378 [PubMed]
    3. Stroes (2014) J Am Coll Cardiol 63(23):2541-8 [PubMed]
Medication Costs
praluent (on 10/19/2016 at Medicaid.Gov Pharmacy Drug pricing)
PRALUENT 150 MG/ML PEN $531.64 per ml
PRALUENT 75 MG/ML PEN $540.44 per ml
repatha (on 3/22/2017 at Medicaid.Gov Pharmacy Drug pricing)
REPATHA 140 MG/ML SURECLICK $540.38 per ml
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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