Repatha vs. Leqvio
See how Repatha and Leqvio compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Repatha is FDA-approved to reduce heart attack and stroke risk, while Leqvio is approved only for lowering LDL cholesterol, not for preventing cardiovascular events.
Leqvio needs just two injections a year after an initial starter dose, while Repatha is injected every two weeks or once a month depending on the regimen.
Repatha is a monoclonal antibody that blocks PCSK9 protein directly, while Leqvio uses siRNA technology to stop the liver from making PCSK9 in the first place.
Repatha vs. Leqvio Drug Summary
Repatha
Repatha (evolocumab) is a PCSK9 inhibitor given by injection to lower LDL cholesterol and reduce the risk of heart attack, stroke, and certain heart procedures in adults with cardiovascular disease. It is also used for inherited high cholesterol conditions in adults and children 10 and older. Most people take it every two weeks or once a month, depending on the dose chosen.
Leqvio
Leqvio (inclisiran) is a PCSK9 synthesis inhibitor that uses siRNA technology to lower LDL cholesterol as an add-on to diet and exercise. It is approved for adults with high cholesterol and for adolescents 12 and older with certain inherited forms of high cholesterol. After two starter doses, it only needs to be injected once every six months.
Repatha vs. Leqvio Side Effects
Repatha
Leqvio
Repatha vs. Leqvio Dosage
Repatha
Leqvio
| STAGE | DOSE | WHEN |
| Starting dose | 140 mg every 2 weeks | At the start |
| Maximum dose | 420 mg every 2 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 284 mg injection | Day 1 |
| Maximum dose | 284 mg injection | Same as starting |
| Dose changes | None | Fixed dose |
Repatha
| STAGE | DOSE | WHEN |
| Starting dose | 140 mg every 2 weeks | At the start |
| Maximum dose | 420 mg every 2 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
Leqvio
| STAGE | DOSE | WHEN |
| Starting dose | 284 mg injection | Day 1 |
| Maximum dose | 284 mg injection | Same as starting |
| Dose changes | None | Fixed dose |
Repatha vs. Leqvio Indications
Repatha
Repatha is FDA-approved to lower LDL cholesterol and reduce heart attack, stroke, and revascularization risk in adults with cardiovascular disease. It is also approved for heterozygous and homozygous familial hypercholesterolemia in patients 10 and older, as an add-on to other LDL-lowering therapies.
Reduces heart attack and stroke risk in adults with heart disease
Treats heterozygous familial hypercholesterolemia (ages 10+)
Treats homozygous familial hypercholesterolemia (ages 10+)
Used alongside diet and other LDL-lowering therapies
Leqvio
Leqvio is FDA-approved as an add-on to diet and exercise to lower LDL cholesterol in adults with hypercholesterolemia. It is also approved for adolescents 12 and older with heterozygous or homozygous familial hypercholesterolemia, as an add-on to standard lipid-lowering care.
Lowers LDL cholesterol in adults with hypercholesterolemia
Treats heterozygous familial hypercholesterolemia (ages 12+)
Treats homozygous familial hypercholesterolemia (ages 12+)
Used alongside diet and exercise as standard care
Repatha vs. Leqvio Pros and Cons
Repatha
Repatha is backed by a large outcomes trial showing it reduces heart attack and stroke risk, not just cholesterol levels. It requires injections every two weeks or month, more often than Leqvio, and remains a brand-name biologic with no biosimilar competition yet.
Pros
Backed by a large outcomes trial (FOURIER) showing reduced heart attack and stroke risk
FDA-approved specifically for cardiovascular risk reduction, not just LDL lowering
Approved for children as young as 10 with familial hypercholesterolemia
Cons
Requires injections every 2 weeks or monthly, more often than Leqvio
No FDA-approved biosimilar competition, keeping brand-name pricing in place
Needle cover contains latex, a risk for latex-sensitive patients
Leqvio
Leqvio offers the least frequent dosing of any injectable cholesterol drug, needing only two shots a year after the starter doses. It is newer to the market with less long-term outcome data, and its label does not yet include cardiovascular event risk reduction.
Pros
Only needs an injection twice a year after two starter doses
Uses newer siRNA technology to reduce the liver's own PCSK9 production
Lower injection frequency may improve long-term adherence
Cons
Not FDA-approved to reduce cardiovascular event risk, only to lower LDL-C
Carries a post-marketing risk of anaphylaxis and angioedema
Not approved for homozygous familial hypercholesterolemia in adults, only adolescents
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