Praluent vs. Leqvio

See how Praluent and Leqvio compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Praluent is dosed every two weeks or monthly, while Leqvio needs only two starter shots followed by one injection every six months.

  • Praluent has FDA-approved outcomes data showing it lowers heart attack and stroke risk after a cardiac event; Leqvio's approval is limited to lowering LDL cholesterol.

  • Both drugs target the PCSK9 protein to lower LDL cholesterol, but they work through different mechanisms: an antibody that blocks it versus an RNA therapy that silences its production.

Praluent vs. Leqvio Drug Summary

Praluent

Praluent (alirocumab) is a PCSK9 inhibitor given by self-injection to lower LDL cholesterol in adults with high cholesterol or heart disease. It's dosed every two weeks or once a month, depending on the strength prescribed. It's also approved to reduce the risk of heart attack, stroke, and hospitalization for unstable angina in people with existing cardiovascular disease.

Leqvio

Leqvio (inclisiran) is a PCSK9 synthesis inhibitor that uses siRNA technology to block production of a cholesterol-raising protein in the liver. After two starter doses given three months apart, it's maintained with just one injection every six months. It's approved to lower LDL cholesterol in adults and in certain pediatric patients with inherited high cholesterol.

Praluent vs. Leqvio Side Effects

Praluent

Most common
nasopharyngitis (up to 11.3%)
injection site reactions (up to 7.2%)
influenza (up to 5.7%)
urinary tract infection (up to 4.8%)

Leqvio

Most common
injection site reaction (3% or greater)
arthralgia (3% or greater)
bronchitis (3% or greater)
hypersensitivity (reported post-marketing)

Praluent vs. Leqvio Dosage

Praluent

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 75 mg every 2 weeks At the start
Maximum dose 300 mg every 4 weeks If needed
Dose changes 2 increases As tolerated

Leqvio

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 284 mg injection Day 1
Maximum dose 284 mg every 6 months Month 9 onward
Dose changes 1 increase As tolerated

Praluent vs. Leqvio Indications

Praluent

Praluent is FDA-approved for adults with primary hyperlipidemia who need additional LDL-lowering beyond diet and maximally tolerated statins. It also treats heterozygous familial hypercholesterolemia in adults and children 8 and older, and it's approved to cut the risk of heart attack, stroke, and hospitalization for unstable angina in adults with existing cardiovascular disease.

  • Add-on therapy for high LDL cholesterol with statins

  • Heterozygous familial hypercholesterolemia (age 8+)

  • Reduces heart attack and stroke risk after cardiovascular disease

  • Reduces hospitalization risk for unstable angina

Leqvio

Leqvio is FDA-approved as an add-on to diet and exercise for adults with high LDL cholesterol, as well as for adults and children 12 and older with heterozygous familial hypercholesterolemia. It's also approved for pediatric patients 12 and older with the more severe homozygous form of the condition.

  • Add-on therapy for high LDL cholesterol

  • Heterozygous familial hypercholesterolemia (age 12+)

  • Homozygous familial hypercholesterolemia in pediatric patients 12+

  • Not indicated for reducing cardiovascular event risk

Praluent vs. Leqvio Pros and Cons

Praluent

Praluent has been available since 2015 and includes outcomes data showing it reduces cardiovascular events, giving it a broader FDA label than Leqvio. It requires more frequent injections, which some patients find burdensome, and carries a specific warning about serious hypersensitivity reactions.

Pros

  • FDA-approved to reduce heart attack and stroke risk after cardiovascular disease

  • Approved for children as young as 8 with familial hypercholesterolemia

  • Flexible dosing: every 2 weeks or once monthly

  • Nearly a decade of real-world use and outcomes data

Cons

  • Requires injections every 2 to 4 weeks, more often than Leqvio

  • Carries a warning for serious hypersensitivity reactions including vasculitis

  • No generic or biosimilar option currently available

Leqvio

Leqvio, approved in 2021, stands out for needing only two injections a year after the starter doses, the least frequent schedule of any LDL-lowering injectable. Its FDA approval doesn't yet include cardiovascular event risk reduction, and there's less long-term outcomes data compared with Praluent.

Pros

  • Only 2 injections a year after the initial starter doses

  • Approved for pediatric homozygous familial hypercholesterolemia (age 12+)

  • No boxed warning on the current label

  • Different siRNA mechanism, an option for patients who don't tolerate antibody-based PCSK9 inhibitors

Cons

  • Not approved to reduce risk of heart attack, stroke, or hospitalization

  • Less real-world outcomes data since its 2021 approval

  • Not approved for adults with homozygous familial hypercholesterolemia

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.