Repatha vs. Praluent
See how Repatha and Praluent compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Repatha and Praluent are both injectable PCSK9 inhibitors that lower LDL cholesterol and reduce cardiovascular risk, but they differ in dosing schedules, device options, and approved patient groups.
Repatha is the only one of the two approved for homozygous familial hypercholesterolemia, while Praluent covers a broader primary hyperlipidemia population and children as young as 8.
Both drugs share similar common side effects, including nasopharyngitis, flu-like symptoms, and injection site reactions, and both require ongoing subcutaneous injections rather than pills.
Repatha vs. Praluent Drug Summary
Repatha
Repatha (evolocumab) is a PCSK9 inhibitor given by subcutaneous injection to lower LDL cholesterol and reduce the risk of heart attack, stroke, and certain heart procedures in adults with cardiovascular disease. It's also approved for familial hypercholesterolemia, including the homozygous form, in patients 10 and older. Repatha is dosed every 2 weeks or once monthly, using a prefilled syringe, autoinjector, or on-body infusor.
Praluent
Praluent (alirocumab) is a PCSK9 inhibitor given by subcutaneous injection to lower LDL cholesterol in adults with primary hyperlipidemia or heterozygous familial hypercholesterolemia, and to reduce cardiovascular risk after a heart attack or unstable angina. It's approved for children as young as 8 with familial hypercholesterolemia. Praluent is dosed every 2 weeks or every 4 weeks using a prefilled pen.
Repatha vs. Praluent Side Effects
Repatha
Praluent
Repatha vs. Praluent Dosage
Repatha
Praluent
| 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 | 75 mg every 2 weeks | At the start |
| Maximum dose | 300 mg every 4 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
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 |
Praluent
| 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 |
Repatha vs. Praluent Indications
Repatha
Repatha is FDA-approved to lower cardiovascular risk in adults with established heart disease and to lower LDL cholesterol in people with familial hypercholesterolemia, including the homozygous form. It's used alongside diet and other LDL-lowering therapies rather than as a replacement for them.
Reduces heart attack, stroke, and revascularization risk in ASCVD
Lowers LDL in heterozygous familial hypercholesterolemia (ages 10+)
Lowers LDL in homozygous familial hypercholesterolemia (ages 10+)
Used as an add-on to diet and other LDL-lowering medications
Praluent
Praluent is FDA-approved to lower LDL cholesterol in adults with primary hyperlipidemia on top of statin therapy, and to treat heterozygous familial hypercholesterolemia starting at age 8. It also reduces cardiovascular risk in adults with a recent heart attack or unstable angina.
Lowers LDL cholesterol in primary hyperlipidemia, added to statins
Treats heterozygous familial hypercholesterolemia (ages 8+)
Reduces cardiovascular events after heart attack or unstable angina
Used alongside diet and maximally tolerated statin therapy
Repatha vs. Praluent Pros and Cons
Repatha
Repatha covers the widest range of familial hypercholesterolemia types, including the homozygous form that Praluent does not treat. It also offers more device choices, but like Praluent, it has no generic or biosimilar competition, so out-of-pocket costs can be high without insurance.
Pros
Only PCSK9 inhibitor approved for homozygous familial hypercholesterolemia
Available in three device formats, including a hands-free on-body infusor
Offers a once-monthly maintenance dose alongside biweekly options
Cons
Not approved for general primary hyperlipidemia without CVD or FH, unlike Praluent
Needle cover contains latex, a risk for latex-sensitive patients
Pediatric approval starts at age 10, older than Praluent's age 8 cutoff
Praluent
Praluent covers a broader everyday-use population, including general primary hyperlipidemia patients, and is approved for younger children with familial hypercholesterolemia. It comes in only one device format, and like Repatha, it has no generic competition, so out-of-pocket costs can be high without insurance.
Pros
Approved for the broader primary hyperlipidemia population, added to statins
Approved for children as young as 8 with familial hypercholesterolemia
Offered as a single prefilled pen across all doses, simplifying injections
Cons
Not approved for homozygous familial hypercholesterolemia, unlike Repatha
Carries a specific warning for serious hypersensitivity reactions, including vasculitis
Only available as a prefilled pen, with no on-body infusor option
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