Evolocumab

How it works

It binds and inhibits proprotein convertase subtilisin/kexin type 9, preventing degradation of hepatic LDL receptors so more receptors recycle to the cell surface and clear LDL cholesterol from the blood.

Prescribing in practice

• It is contraindicated in patients with a known hypersensitivity to the product, and injection-site reactions and occasional hypersensitivity are the main safety concerns.
• It is used as an adjunct to diet and maximally tolerated statin therapy, or alone or with other agents when statins are not tolerated.
• NICE restricts use to defined LDL thresholds depending on cardiovascular risk category.

Monitoring

Lipid profile is checked to confirm response, but routine ongoing laboratory monitoring of the drug itself is not generally required.

Counselling the patient

• Rotate injection sites and allow the pen or syringe to reach room temperature before injecting.
• Continue your statin and lifestyle measures unless told otherwise.
• Store in the refrigerator and protect from light.

Evidence & guidelines

The FOURIER trial showed evolocumab reduced cardiovascular events on top of statin therapy, underpinning its NICE-approved cardiovascular indications.