Crestor vs. Leqvio
See how Crestor and Leqvio compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Crestor is a daily statin pill with decades of proven heart attack and stroke risk reduction, while Leqvio is a twice-yearly injection that only lowers LDL cholesterol without long-term outcomes data yet.
Generic rosuvastatin costs very little out of pocket, while Leqvio's list price runs into the thousands of dollars per injection and usually needs insurance prior authorization.
Leqvio is typically reserved for patients who can't reach their LDL goal on statins like Crestor, or who can't tolerate statin muscle side effects.
Crestor vs. Leqvio Drug Summary
Crestor
Crestor (rosuvastatin) is a statin that blocks the liver enzyme responsible for making cholesterol. It's taken as a once-daily tablet to lower LDL cholesterol and triglycerides, and in certain higher-risk adults, to reduce the chance of heart attack and stroke.
Leqvio
Leqvio (inclisiran) is a small interfering RNA (siRNA) therapy that blocks the liver from making PCSK9, a protein that limits how well the body clears LDL cholesterol. It's given as a subcutaneous injection by a healthcare provider, with only two doses a year after the first two starter doses.
Crestor vs. Leqvio Side Effects
Crestor
Leqvio
Crestor vs. Leqvio Dosage
Crestor
Leqvio
| STAGE | DOSE | WHEN |
| Starting dose | 5-10 mg once daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 284 mg single injection | Day 1 |
| Maximum dose | 284 mg single injection | Same as starting |
| Dose changes | None | Fixed dose |
Crestor
| STAGE | DOSE | WHEN |
| Starting dose | 5-10 mg once daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Leqvio
| STAGE | DOSE | WHEN |
| Starting dose | 284 mg single injection | Day 1 |
| Maximum dose | 284 mg single injection | Same as starting |
| Dose changes | None | Fixed dose |
Crestor vs. Leqvio Indications
Crestor
Crestor is FDA-approved to lower LDL cholesterol, total cholesterol, and triglycerides in adults with high cholesterol or mixed dyslipidemia. It's also approved to reduce the risk of heart attack, stroke, and artery-opening procedures in people with cardiovascular risk factors, and to treat inherited high cholesterol conditions starting in childhood.
Lowers LDL-C, total cholesterol, and triglycerides in high cholesterol
Reduces heart attack, stroke, and revascularization risk in at-risk adults
Treats heterozygous and homozygous familial hypercholesterolemia
Slows the progression of atherosclerosis
Leqvio
Leqvio is FDA-approved as an add-on to diet and exercise to lower LDL cholesterol in adults with high cholesterol. It's also approved for heterozygous and homozygous familial hypercholesterolemia in patients 12 and older, but it hasn't yet been shown to reduce heart attacks or strokes.
Lowers LDL-C as an add-on to diet and exercise
Treats heterozygous familial hypercholesterolemia in patients 12 and up
Treats homozygous familial hypercholesterolemia in pediatric patients 12+
Not yet proven to reduce heart attack or stroke risk
Crestor vs. Leqvio Pros and Cons
Crestor
Crestor has decades of outcomes data showing it lowers cardiovascular risk, and it's available as an inexpensive, widely covered generic. Daily pill-taking and a long list of drug interactions are the main trade-offs.
Pros
Decades of outcomes data proving reduced heart attack and stroke risk
Generic rosuvastatin costs roughly $10 to $25 a month without insurance
Taken as a pill, with no injections or office visits required
Once-daily dosing that works around a patient's own schedule
Cons
Requires daily adherence, unlike Leqvio's twice-yearly schedule
Muscle aches (myalgia) are a common reason patients stop taking it
Long list of drug interactions that can require dose limits
Periodic liver enzyme monitoring is recommended
Leqvio
Leqvio offers LDL-lowering with only two injections a year, which appeals to patients who struggle with daily pills. It carries a much higher price tag, needs a provider visit for each dose, and hasn't yet proven it lowers heart attack or stroke risk.
Pros
Only two injections a year after the first two starter doses
Removes daily pill adherence as a barrier to LDL control
No known interaction with statins or common CYP450 drugs
Given by a provider, so there's no at-home dosing to forget
Cons
Costs roughly $6,500 to $10,800 a year at list price before assistance
Needs a provider office visit for every dose
Not yet shown to lower heart attack or stroke risk, unlike Crestor
Injection site reactions occur in a meaningful share of patients
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