evolocumab
Repatha (evolocumab) is a PCSK9 inhibitor from Amgen. By protecting LDL receptors from destruction, it dramatically lowers LDL cholesterol and reduces major cardiovascular events in adults at increased risk.
This page is based on the EMA medicine record and the DailyMed label for evolocumab; the mechanism is explained in plain language, and analogies are used only where they stay accurate.
How it works
Explains what the medicine does in the body, not dosing, side effects, or safety.
An analogy
The liver clears LDL cholesterol with catcher's mitts, the LDL receptors. PCSK9 is a shredder that destroys mitts after each catch. Evolocumab ties up the shredder, so the mitts keep working round after round, pulling far more LDL out of the bloodstream.
In simple terms
LDL cholesterol is removed from the blood by receptors on liver cells. A protein called PCSK9 causes those receptors to be broken down, limiting how much cholesterol can be cleared. Evolocumab is an antibody that binds PCSK9 and stops it. More receptors survive on the liver surface, LDL levels fall sharply, and lower LDL translates into fewer heart attacks and strokes.
In depth
Evolocumab is a fully human IgG2 monoclonal antibody that binds PCSK9 with high affinity, preventing it from interacting with the epidermal growth factor-like repeat A domain of the hepatic LDL receptor. Without PCSK9-mediated degradation, LDL receptors recycle to the hepatocyte surface, increasing LDL uptake and lowering circulating LDL-C by roughly half when added to statins. Outcome trials demonstrated reductions in cardiovascular death, myocardial infarction and stroke in high-risk patients.
See it in motion
A schematic animation of the mechanism — simplified for clarity, not drawn to scale.
How evolocumab ties up PCSK9 to preserve LDL receptors
- The liver clears LDL cholesterol with catcher's mitts, the LDL receptors. PCSK9 is a shredder that destroys mitts after each catch.
- Evolocumab is a fully human IgG2 monoclonal antibody that binds PCSK9 with high affinity, preventing it from interacting with the epidermal growth factor-like repeat A domain of the hepatic LDL receptor.
- Without PCSK9-mediated degradation, LDL receptors recycle to the hepatocyte surface, increasing LDL uptake and lowering circulating LDL-C by roughly half when added to statins.
- Outcome trials demonstrated reductions in cardiovascular death, myocardial infarction and stroke in high-risk patients.
Target: PCSK9
A protein that tags LDL receptors for destruction; when PCSK9 is blocked, more receptors remain on liver cells to clear LDL cholesterol from the blood.
Approved uses
Approved uses differ by country and change over time. Always follow your local prescribing information.
Approved uses in United States
FDA- To reduce the risk of major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, unstable angina requiring hospitalization or coronary revascularization) in adults at increased risk
- As an adjunct to diet and exercise, to reduce LDL cholesterol in adults with hypercholesterolemia
Approved uses in European Union
EMA- In adults with primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia, as an adjunct to diet, in combination with a statin or statin with other lipid-lowering therapies in patients unable to reach LDL-C goals with the maximum tolerated statin dose, or alone or in combination with other lipid-lowering therapies in patients who are statin-intolerant or for whom a statin is contraindicated
Official sources
The statements on this page trace back to these records.
- Repatha (evolocumab) — Summary of product characteristics and package leaflet, English version
European Medicines Agency
- DailyMed: Repatha (evolocumab) label
DailyMed, U.S. National Library of Medicine
- Emc SmPC: Evolocumab (UK licensed product)
Medicines and Healthcare products Regulatory Agency (EMC)
This page explains how the medicine works — it isn’t the patient leaflet. For anything that applies to you, read the leaflet that came with your medicine or ask your pharmacist.
MedUnfold provides educational content and is not medical advice. Always follow your local prescribing information and healthcare professional.