Evolocumab is one of a new group of genetically engineered drugs designed to improve blood cholesterol levels.
There are two main types of cholesterol. High-density lipoprotein (HDL) is one type of cholesterol. It helps to remove harmful cholesterol from your blood. High HDL cholesterol may help protect you from heart disease.
Low-density lipoprotein (LDL) cholesterol is the second type of cholesterol. High levels of LDL can lead to a build-up of lipid plaque in your arteries. This increases your risk of heart disease and peripheral artery disease. It also raises your risk of suffering a heart attack or stroke. If you have high LDL cholesterol, consult your doctor about how to get it under control and reduce your risk.
Changes to your diet and regular exercise can help lower your LDL cholesterol levels. Medications, such as statins, have also proved effective in lowering cholesterol.
Evolocumab isn’t an option at this time because it has yet to be approved by the U.S. Food and Drug Administration (FDA). However, it is a promising new treatment for high cholesterol.
Evolocumab works by targeting a specific gene called proprotein convertase subtilisin/kexin type 9 (PCSK9). This gene affects the number of LDL receptors in your body. LDL receptors are important because they control how much LDL cholesterol can enter your bloodstream.
If you carry a certain genetic mutation, your body may not be able to regulate LDL cholesterol as well as it should. That’s why high cholesterol might run in your family.
Evolocumab suppresses the enzyme expressed by the PCSK9 gene. This is why it’s called a PCSK9-inhibitor. Suppressing the enzyme leads to more LDL receptors. This means less LDL cholesterol can get into your bloodstream. This, in turn, leads to a lowering of LDL levels, which is a great thing for your heart.
In clinical trials, evolocumab reduced LDL cholesterol by about 60 percent. One year later, less than 1 percent of study participants taking the drug experienced a major heart-related event. Among those in the standard-therapy group, the rate was notably higher at slightly more than 2 percent.
Evolocumab must be administered by subcutaneous injection. In clinical trials, participants received a dose of 420 mg once a month or 140 mg every two weeks. One method of dosing was not shown to be significantly more effective than the other.
In a study supported by the biopharmaceutical company Amgen, adverse events were reported in about 69 percent of patients taking evolocumab versus just under 65 percent in the standard-therapy group. The most common side effect was injection site reaction. Other side effects included:
- elevated liver enzymes (aminotransferase) or creatine kinase levels
- neurocognitive events
- limb pain
- joint pain (arthralgia)
Like statins, evolocumab is not a short-term treatment. At this time, the dangers of long-term use are unknown.
Statins have been shown to significantly lower LDL cholesterol. They work by blocking an enzyme called HMG-CoA reductase. Your liver needs this enzyme to make cholesterol. Statins may also make it easier for your body to reabsorb cholesterol that has built up in your arteries.
Most people can take statins with minimal side effects, which may include digestive issues or muscle aches. Potentially serious side effects include:
- permanent muscle damage
- liver damage (indicated by elevated liver enzymes)
- increased blood sugar levels, which may lead to type 2 diabetes
- memory loss
Your doctor can inform you of long-term benefits and risks.
Statins are available in a variety of doses. There are several generics and brand names from which to choose. Generic statins can cost as little as a few dollars per month. Brand names can cost several hundred dollars per month.
Evolocumab has also been shown to be very effective in lowering LDL cholesterol. Clinical trials have helped researchers identify side effects and potential risks. Because evolocumab is still in development, there’s insufficient data to determine if it will be safe and effective in the long term.
Evolocumab will not be available in tablet form. It must be injected. In general, biologic drugs like evolocumab are relatively expensive when compared to generic statins.
Whether you are taking statins or evolocumab, cholesterol-lowering drugs must be taken consistently and for the long haul.
Statins are the current go-to medication for high cholesterol. If evolocumab gets full FDA approval and makes it to market, doctors and patients will have some decisions to make, not the least of which is the cost factor.
Knowing your HDL and LDL cholesterol numbers is important. If you have high cholesterol, discuss your options with your doctor. In some cases, a few lifestyle changes are enough to bring your numbers down to the normal ranges.
If your doctor recommends statins, ask about brand name versus generic versions. See your doctor regularly and report side effects. Sometimes the initial dose may need to be adjusted. Even if you take statins, you still need to make healthy lifestyle choices.
Evolocumab appears to have a powerful effect on cholesterol levels, but more research is needed before the FDA can issue final approval for this drug.