Evinacumab

How it works

It inhibits angiopoietin-like protein 3 (ANGPTL3), enhancing lipoprotein and endothelial lipase activity to lower LDL-cholesterol through a pathway largely independent of the LDL receptor.

Prescribing in practice

• Serious hypersensitivity reactions, including anaphylaxis, have been reported, so it should be given where such reactions can be managed and the infusion stopped if they occur.
• It is indicated specifically as an adjunct to diet and other LDL-lowering treatments in homozygous familial hypercholesterolaemia, not for general hypercholesterolaemia.
• Effective contraception is advised because of potential foetal harm, and treatment should be initiated and supervised by a specialist.

Monitoring

Monitor LDL-cholesterol response and observe for infusion-related and hypersensitivity reactions during and after administration.

Counselling the patient

• This is given as a hospital infusion under specialist supervision.
• Report rash, swelling, breathlessness or other reaction during or after the infusion.
• Use reliable contraception and discuss pregnancy plans with your specialist.

Evidence & guidelines

The ELIPSE HoFH trial demonstrated substantial LDL-cholesterol reduction with evinacumab in homozygous familial hypercholesterolaemia, supporting its specialist adjunctive role.