A Closer Look at PCSK9 Inhibitors: Evolocumab (Repatha) and Alirocumab (Praluent)

There’s a new class of cholesterol medications on the market and they could be more powerful than statins. It’s a game changing possibility that could help patients across the United States who struggle to lower their LDL cholesterol levels, the “bad” type of cholesterol that can cause serious health problems. The new medications are known as PCSK9 inhibitors.

“The new drugs, called PCSK9 inhibitors, are monoclonal antibodies. They target and inactivate a specific protein in the liver,” explained Dr. Gregory Curfman, the Editor in Chief of Harvard Health Publications, on the Harvard Health Blog. “Knocking out this protein, called proprotein convertase subtilisin kexin 9, dramatically reduces the amount of harmful LDL cholesterol circulating in the bloodstream.”

New to the market, PCSK9 inhibitors were only approved by the FDA in 2015. These drugs include evolocumab and alirocumab. They are given to patients to self-administer through subcutaneous injections, which means the medication is given through a shot beneath the skin. PCSK9 inhibitors are not generally prescribed as a patient’s first cholesterol treatment, but rather they are used after a patient doesn’t respond to statins.

Statins are the traditional medications used to treat high cholesterol. They work by blocking an enzyme called hydroxy-methylglutaryl-coenzyme A reductase, which produces cholesterol in the liver.

Evolocumab and alirocumab can be used as stand-alone treatments or in combination with a statin. In one study, published by the New England Journal of Medicine, the use of evolocumab combined with standard therapy was compared to the use of only standard therapy. Researchers found that the combination treatment lowered the level of LDL cholesterol by 61 percent.

According to the Center for Disease Control and Prevention (CDC), more than 35 million Americans have cholesterol levels that put them at risk for heart disease. While high cholesterol levels can be brought down by diet and exercise, many people need the extra help that medications provide. PCSK9 inhibitors could be the next step in the battle against heart disease.