II. Mechanism

  1. Monoclonal antibodies (PCSK9 Inhibitor)

III. Indications

  1. Severe familial Hypercholesterolemia (e.g. LDL Cholesterol >190 mg/dl)

IV. Background

  1. Available in U.S. as of 2015

V. Preparations

  1. Praluent (Alirocumab)
  2. Repatha (Evolocumab)

VI. Efficacy

  1. See disadvantages below
  2. Lower LDL Cholesterol up to 60%
  3. Repatha added to Statin for 2 years prevents one more CV event per 74 treated ($2,000,000 per CV event prevented)
    1. Alkhalil (2017) JAMA 317(16):1690-1691 +PMID: 28444271 [PubMed]

VII. Disadvantages

  1. Very expensive agents ($14,000 per year)
    1. Contrast with Statins which cost $250 per year
    2. Statin alone for 5 years prevents one more fatal CV event per 39 treated ($48,000 per fatal CV event prevented)
  2. New, with only short-term data
    1. Unknown longterm safety
    2. Unknown mortality reduction (contrast with proven Statin efficacy)

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Cost: Medications

praluent (on 10/19/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
PRALUENT 150 MG/ML PEN $531.64 per ml
PRALUENT 75 MG/ML PEN $540.44 per ml
repatha (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
REPATHA 140 MG/ML SURECLICK $540.38 per ml