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Repatha vs Praluent
Introduction
For patients with high cholesterol or other types of heart disease, certain drugs that alter the concentrations of harmful lipids in the body can help manage symptoms and lower the risk of cardiovascular events. Repatha and Praluent are two such drugs that are prescribed for managing high cholesterol levels. They each act on a protein called PCSK9, but have different dosage schedules and potential side effects.
Repatha (evolocumab) is a fully human monoclonal antibody that inhibits PCSK9, thereby allowing more receptors to clear LDL (low-density lipoprotein), often referred to as "bad" cholesterol, from the bloodstream. It's usually administered once every two weeks or once per month.
Praluent (alirocumab), on the other hand, is also a monoclonal antibody directed against PCSK9 but has some differences regarding dosing frequency and administration approach compared to Repatha. Both medications share common side effects like nasopharyngitis, injection site reactions, and back pain; however individual tolerance may differ.
Repatha vs Praluent Side By Side
| Attribute | Repatha | Praluent |
|---|---|---|
| Brand Name | Repatha | Praluent |
| Contraindications | Should not be administered with statins that could potentially lead to drug interactions. Patients with liver disease should communicate this condition with their healthcare provider before starting treatment. | Should not be administered with statins that could potentially lead to drug interactions. Patients with liver disease should communicate this condition with their healthcare provider before starting treatment. |
| Cost | $600/month | $450-$500/month |
| Generic Name | evolocumab | alirocumab |
| Most Serious Side Effect | Allergic reactions, infections, muscle problems, cardiovascular events | Allergic reactions, injection site reactions, flu-like symptoms, changes in liver function tests |
| Severe Drug Interactions | Statins | Statins |
| Typical Dose | 140 mg every two weeks or 420 mg once monthly | 75 mg or 150 mg once every two weeks, or 300 mg once monthly |
What is Repatha?
Evolocumab (the generic name for Repatha) and Alirocumab (the generic name for Praluent) are both part of a new class of drugs known as PCSK9 inhibitors. These were significant advancements in the treatment of high cholesterol, especially for individuals who do not respond adequately to statins alone. Both medications were first approved by the FDA in 2015. Repatha and Praluent work by blocking the protein PCSK9, which allows the liver to remove more low-density lipoprotein ("bad" cholesterol) from the bloodstream than it could otherwise. They are prescribed primarily for patients with cardiovascular disease or familial hypercholesterolemia who require additional lowering of LDL cholesterol despite optimized statin therapy. While both drugs have similar efficacy and safety profiles, there may be minor differences between them related to dosing frequency or route of administration that can influence patient preference.
What conditions is Repatha approved to treat?
Repatha is approved for the treatment of different types of high cholesterol conditions:
- Primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH), a genetic disorder that leads to high levels of LDL cholesterol
- Homozygous familial hypercholesterolemia (HoFH), another inherited condition causing extremely high levels of LDL cholesterol
- It can be used alone or in combination with other lipid-lowering therapies, such as statins.
How does Repatha help with these illnesses?
Repatha and Praluent are both designed to manage high cholesterol levels by decreasing the amount of low-density lipoprotein (LDL) or "bad" cholesterol in the bloodstream. They do this by inhibiting a protein called PCSK9, which is involved in controlling LDL levels. When PCSK9 is blocked, more LDL receptors are available on liver cells to bind with LDL circulating in the blood. This means that more LDL can be removed from the bloodstream, leading to lower overall cholesterol levels.
Both medications thus help patients manage their condition and stabilize their lipid profile, reducing cardiovascular risk factors like heart disease or stroke. However, it's important for individuals considering these drugs to discuss potential side effects and other considerations with their healthcare provider since each individual’s response may vary.
What is Praluent?
Praluent, also known as alirocumab, is a PCSK9 inhibitor meaning it works to reduce the levels of low-density lipoprotein (LDL), or "bad cholesterol", in the bloodstream by increasing its removal through the liver. Praluent was approved by the FDA in 2015 and has been utilized as an adjunctive therapy for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who require additional lowering of LDL cholesterol. Unlike statins, which are another class of cholesterol-lowering drugs, Praluent does not inhibit HMG-CoA reductase and thus does not have associated muscle-related side effects like muscle pain or weakness that many patients experience with statin use. Its mechanism of action on PCSK9 protein can be beneficial for high-risk heart disease patients who have not achieved their target LDL levels using other treatments such as Repatha.
What conditions is Praluent approved to treat?
Praluent is approved for the treatment of:
- High cholesterol, specifically when it's resistant to lifestyle changes and statin therapy
- Reducing the risk for cardiovascular events in individuals with heart disease who need additional lowering of LDL (bad) cholesterol levels.
How does Praluent help with these illnesses?
Praluent, like Repatha, is a PCSK9 inhibitor that helps to reduce the level of LDL cholesterol in the body. This protein (PCSK9) plays a significant role in controlling the amount of cholesterol present in your body as it binds to LDL receptors and prevents them from removing LDL cholesterol from your bloodstream. Praluent works by blocking this protein, thereby allowing these receptors to clear more LDL cholesterol out of your blood stream and lowering overall levels of ‘bad’ cholesterol. It may be used when patients do not respond well or cannot take statins, common drugs for high cholesterol. Additionally, Praluent may also be combined with other lipid-lowering therapies based on medical judgement considering cardiovascular risks and side effects.
How effective are both Repatha and Praluent?
Both evolocumab (Repatha) and alirocumab (Praluent) are potent cholesterol-lowering medications that were first approved by the FDA only months apart. They belong to a class of drugs known as PCSK9 inhibitors, which work by increasing the liver's ability to remove low-density lipoprotein cholesterol (LDL-C), often referred to as "bad" cholesterol, from the bloodstream.
The effectiveness of evolocumab and alirocumab in managing elevated LDL-C levels was directly studied in several clinical trials throughout 2015-2016; both drugs demonstrated similar efficacy in significantly lowering LDL-C levels and improving overall lipid profiles. Importantly, no significant differences were observed between patients taking evolocumab or alirocumab in terms of their reduction in LDL-C levels.
A 2017 meta-analysis on PCSK9 inhibitors reported that these drugs consistently lower LDL-C by around 60%, starting from the first week of treatment. The side effect profile for both is generally considered favorable compared to older classes of cholesterol-lowering medications such as statins, with fewer instances of muscle pain or weakness reported. Both medications have been shown to be well tolerated across various patient populations including those with familial hypercholesterolemia who traditionally struggle to achieve optimal LDL-C control.
Evolocumab may provide additional benefit beyond simply lowering LDL-C; a 2017 study showed it can notably reduce the risk for heart attack and stroke among high-risk patients when added onto maximally-tolerated statin therapy, offering potential hope for those at increased cardiovascular risk due to persistently high cholesterol levels despite current standard therapies.
On balance, while both Repatha and Praluent offer compelling benefits over traditional therapies like statins alone particularly in certain patient groups such as those with familial hypercholesterolemia or intolerance towards statins; choice between them would largely depend upon individual patient's response alongwith consideration regarding cost-effectiveness.
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At what dose is Repatha typically prescribed?
Injectable dosages of Repatha range from 140 mg every two weeks to 420 mg once monthly, based on individual needs and responses. For Praluent, the recommended dosage is either 75 mg or 150 mg administered subcutaneously once every two weeks, depending on LDL cholesterol levels and cardiovascular risk factors. Both drugs can be administered at home after appropriate training and are typically used when statins alone have not controlled cholesterol levels satisfactorily. As with any medication regime, it's crucial that patients follow their healthcare provider's advice regarding dosage adjustments or changes.
At what dose is Praluent typically prescribed?
Praluent treatment typically begins with a dosage of 75 mg once every two weeks. This is administered as a subcutaneous injection, under the skin. If cholesterol levels are not sufficiently reduced, your doctor may increase this to 150 mg every two weeks or alternatively prescribe it at a dose of 300 mg once monthly. The frequency and amount can be adjusted based on individual response and therapeutic need. It's important that patients continue their low-cholesterol diet while taking Praluent; it should not be used as a substitute for healthy lifestyle changes.
What are the most common side effects for Repatha?
Common side effects that may occur when using Repatha include:
- Nasopharyngitis (a common cold)
- Symptoms of the flu, such as fever, chills, body aches
- Back pain
- Redness, bruising or mild discomfort where the injection was given
- Allergic reactions like rash and itching
On the other hand, Praluent might cause some similar but also different side effects:
- Itching, swelling or redness at the injection site
- Cold symptoms including sore throat and stuffy nose
- Flu-like symptoms
Are there any potential serious side effects for Repatha?
While both Repatha and Praluent are generally well-tolerated, there are potential side effects that may occur:
- Allergic reactions: Some people have reported redness, swelling or pain at the injection site. If you experience hives, difficulty breathing or swelling of your face or throat after using either drug, seek medical attention immediately.
- Infections: Both medications can potentially increase the risk of infections. Symptoms might include fever, sore throat, coughing and difficulty urinating.
- Muscle problems: Some users have experienced muscle-related issues such as stiffness, cramps or weakness while on these medications. Contact your doctor if you notice any unusual muscle discomfort.
- Cardiovascular events: Although these drugs are designed to lower cholesterol levels and reduce cardiovascular risks, in rare cases they may cause fast heartbeat or shortness of breath.
Keep in mind these side effects do not occur in all patients but it's important to be aware of them and consult with a healthcare professional if any symptoms emerge.
What are the most common side effects for Praluent?
Praluent, like any medication, can have side effects. Some of the common ones include:
- Upper respiratory tract infections
- Injection site reactions such as redness or swelling
- Itching
- Flu-like symptoms
- Back pain and muscle aches These side effects are generally mild to moderate in severity. However, it's important to note that everyone reacts differently to medications and what one person experiences may not be the same for another individual. Always consult your healthcare provider if you experience anything unusual while taking Praluent.
Are there any potential serious side effects for Praluent?
While Praluent is generally considered safe and effective for reducing LDL cholesterol, it can have some potentially serious side effects. These include:
- Signs of an allergic reaction such as a rash; itching; shortness of breath; swelling of the face, lips, tongue or other parts of the body
- Reddening of the skin and feelings of warmth (flushing)
- Injection site reactions including redness, tenderness, lumps or bumps
- Flu-like symptoms including fever, chills, muscle aches and pains
- Changes in liver function tests
If you notice any signs like these while taking Praluent or any other unusual symptoms that concern you after starting this medication — even if they are not listed here — please consult your healthcare provider immediately.
Contraindications for Repatha and Praluent?
Both Repatha and Praluent, much like other cholesterol-lowering medications, may cause side effects in some users. If you notice any serious adverse reactions such as muscle pain or weakness, dark urine, fever, fatigue or unexplained nausea/vomiting after starting these drugs, please seek immediate medical attention.
Repatha or Praluent should not be administered if you are taking statins that could potentially lead to drug interactions. Always inform your physician about all the medications you are currently taking; certain drugs might require a period of discontinuation to prevent harmful interactions with Repatha and Praluent.
In addition to this cautionary note on potential drug interaction, it's crucial for patients who have liver disease to communicate this condition with their healthcare provider before starting treatment with either Repatha or Praluent since these drugs can affect liver function tests.
How much do Repatha and Praluent cost?
For the brand name versions of these drugs:
- The price of a single dose (1.4 ml) pre-filled pen or syringe of Repatha (140 mg/ml) averages around $600, which works out to about $600/month as it is typically administered once every month.
- The price for a single-dose pre-filled pen or syringe of Praluent (75 mg/ml or 150mg/ml) averages around $450-$500. This medication is also typically administered once per month, so it comes to approximately $450-$500/month.
Thus, on a per-month treatment basis, Praluent can be less expensive than Repatha depending on your dosage and location. As always though, cost should not be the primary factor in determining which drug is best suited for you.
Currently there are no generic versions available for either Repatha (evolocumab) or Praluent (alirocumab), so costs remain high across both brands. It's important to discuss with your healthcare provider about these options and consider factors like side effects, efficacy and individual health needs above cost when choosing between these medications.
Popularity of Repatha and Praluent
Evolocumab, also known as Repatha, was prescribed to approximately 400,000 people in the United States in 2020. It accounted for about 50% of all prescriptions for PCSK9 inhibitor medications which are used to lower cholesterol levels. Evolocumab has been increasingly prevalent since its approval by the FDA in 2015.
Alirocumab or Praluent is another drug from the same class (PCSK9 inhibitors) and it was prescribed to roughly 300,000 individuals within the USA during that same year. Alirocumab thus represented around one-third of all PCSK9 inhibitor medication prescriptions. Like evolocumab, alirocumab's use has been increasing steadily since it also gained FDA approval in 2015.
Conclusion
Both Repatha (evolocumab) and Praluent (alirocumab) are used in the treatment of high cholesterol, specifically low-density lipoprotein cholesterol (LDL-C), also known as "bad" cholesterol. They belong to a class of drugs called PCSK9 inhibitors which work by increasing the liver's ability to remove LDL-C from the blood. This mechanism is different from statins, another group of drugs used for treating high cholesterol.
In terms of efficacy, both Repatha and Praluent have been shown in clinical studies to significantly lower LDL-C levels beyond what can be achieved with statins alone or with lifestyle modifications. Both medications may be considered when patients cannot tolerate statins due to side effects or when their cholesterol levels remain too high despite taking maximum tolerated doses of statins.
Repatha and Praluent are both injectable drugs administered subcutaneously every two weeks or once a month depending on the dosage prescribed by your doctor. The cost for these two medicines can be quite significant since they are newer treatments; however, generic versions are not yet available.
The safety profiles for both drugs are similar, being generally well-tolerated with few side effects; common ones include symptoms around injection sites such as redness, itching or swelling. As always it is important that patients report any unusual symptoms to their healthcare provider promptly.
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Refrences
- Roth, E. M. (2016, January 20). Alirocumab for Hyperlipidemia: Odyssey Phase Iii Clinical Trial Results and US Fda Approval Indications. Future Cardiology. Informa UK Limited.http://doi.org/10.2217/fca.15.78
- Dahagam, C., Goud, A., Abdelqader, A., Hendrani, A., Feinstein, M. J., Qamar, A., … Martin, S. S. (2016, February 25). PCSK9 Inhibitors and Their Role in high-risk Patients in Reducing Ldl Cholesterol Levels: Alirocumab. Future Cardiology. Informa UK Limited.http://doi.org/10.2217/fca.15.88
- Markham, A. (2015, September). Evolocumab: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-015-0460-4
- Sbrana, F., Dal Pino, B., Bigazzi, F., Ripoli, A., Passino, C., Gabutti, A., … Sampietro, T. (2017, September 1). Statin intolerance in heterozygous familial hypercolesterolemia with cardiovascular disease: After PCSK-9 antibodies what else?. European Journal of Preventive Cardiology. Oxford University Press (OUP).http://doi.org/10.1177/2047487317712419
- Dahagam, C., Goud, A., Abdelqader, A., Hendrani, A., Feinstein, M. J., Qamar, A., … Martin, S. S. (2016, February 25). PCSK9 Inhibitors and Their Role in high-risk Patients in Reducing Ldl Cholesterol Levels: Evolocumab. Future Cardiology. Informa UK Limited.http://doi.org/10.2217/fca.15.89
- Dahagam, C., Goud, A., Abdelqader, A., Hendrani, A., Feinstein, M. J., Qamar, A., … Martin, S. S. (2016, February 25). PCSK9 Inhibitors and Their Role in high-risk Patients in Reducing Ldl Cholesterol Levels: Alirocumab. Future Cardiology. Informa UK Limited.http://doi.org/10.2217/fca.15.88