Evolocumab: A Review in Hyperlipidemia

Keating GM
Evolocumab: A Review in Hyperlipidemia. Am J Cardiovasc Drugs 2016;16:67-78.

The following are key points to remember about the role of evolocumab in the management of hyperlipidemia:

  1. Evolocumab is a monoclonal antibody that targets proprotein convertase subtilisin/kexin 9 (PCSK9).
  2. Evolocumab was recently approved for use in primary hypercholesterolemia as well as familial hypercholesterolemia (heterozygous and homozygous).
  3. Evolocumab reduces low-density lipoprotein cholesterol (LDL-C) by as much as 77% when added to statin therapy in patients with primary hypercholesterolemia, 68% in heterozygous familial hypercholesterolemia, and 31% in homozygous familial hypercholesterolemia.
  4. Current guidelines have yet to incorporate the role of evolocumab in the management of hypercholesterolemia. However, based on studies, it would seem to be a reasonable choice in patients who have not achieved the desired LDL-C reduction while already on statins or those who are statin intolerant.
  5. No dose adjustment is needed in patients with mild to moderate hepatic or renal impairment.
  6. Evolocumab is generally well tolerated with no significant safety concerns noted to date.
  7. Evolocumab is administered by subcutaneous injection either once or twice monthly.
  8. A large trial is underway to evaluate the effect of evolocumab on cardiovascular outcomes.

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