PCSK9

Posted On February 20, 2020

• Alirocumab and evolocumab are fully humanized monoclonal antibodies that bind free plasma PCSK9

Mechanism

= Decrease level of PCSK9
= less free PCSK9 is available in plasma to bind to LDL-R
= Increased LDL-R allow the liver to remove more LDL-C

Alirocumab Dose

Hyperlipidemia, primary:
Initial: 75 mg sq every 2 weeks or 300 mg every 4 weeks; for both regimens,
if an adequate LDL-C response is not achieved, may increase or modify dosing regimen to a maximum of 150 mg every 2 weeks.
Note: In patients with heterozygous familial hypercholesterolemia undergoing LDL apheresis, the recommended initial dose is 150 mg every 2 weeks.

Secondary prevention of cardiovascular events after acute coronary syndrome (off-label use) (alternative agent):
75 mg sq every 2 weeks; may increase to a maximum dose of 150 mg every 2 weeks
titrate as needed to maintain a goal LDL cholesterol of 25 to 50 mg/dL

Preparation: 75 or 150 mg/ml
Cost over $600 per ml