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

Most common
Headache (up to 4%)
Myalgia (up to 3%)
Abdominal pain (up to 3%)
Asthenia (up to 3%)

Leqvio

Most common
Injection site reaction (up to 8%)
Bronchitis (up to 4%)
Diarrhea (up to 4%)
Arthralgia (up to 4%)

Crestor vs. Leqvio Dosage

Crestor

Dosage
Dosage Table
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

Dosage
Dosage Table
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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