Evolocumab

How it works

It binds to circulating PCSK9, preventing PCSK9-mediated degradation of hepatic LDL receptors, so more LDL receptors recycle to the cell surface and clear LDL-cholesterol from the blood.

Prescribing in practice

• It is contraindicated in patients with known hypersensitivity to the active substance, and treatment should be considered within the eligibility criteria set out in NICE technology appraisal guidance and local lipid pathways rather than offered as first-line lipid lowering.
• It is given by subcutaneous injection and is intended as an adjunct to maximally tolerated statin therapy and/or other lipid-lowering treatment, or as monotherapy where statins are contraindicated or not tolerated.
• Injection-site reactions are common, and the pre-filled pen should be brought to room temperature before administration and the injection site rotated.

Monitoring

Check the lipid profile to confirm an adequate LDL-cholesterol response and to guide continuation, in line with the relevant prescribing pathway.

Counselling the patient

• Show the patient how to rotate injection sites and store the pen refrigerated, allowing it to reach room temperature before use.
• Explain that this injection is added to, and does not replace, a healthy diet and any prescribed statin therapy.
• Report any persistent injection-site reaction or signs of an allergic reaction.

Evidence & guidelines

The FOURIER trial demonstrated that evolocumab added to statin therapy reduced cardiovascular events in patients with established atherosclerotic cardiovascular disease, and NICE recommends its use within defined eligibility criteria.