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

Most common
nasopharyngitis (up to 10.5%)
upper respiratory tract infection (up to 9.3%)
influenza (up to 7.5%)

Leqvio

Most common
injection site reaction (up to 3%)
arthralgia (up to 3%)
bronchitis (up to 3%)

Repatha vs. Leqvio Dosage

Repatha

Dosage
Dosage Table
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

Dosage
Dosage Table
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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