Is Repatha a statin?

In this article:

• Is Repatha a statin?
• Repatha vs. statins
• Side effects
• Alternatives
• The bottom line

In this article

• Is Repatha a statin?
• Repatha vs. statins
• Side effects
• Alternatives
• The bottom line

If Repatha were ever to leave the market, there are other, non-statin medications doctors can use. Some options include:

Repatha (evolocumab) is a brand-name medication that is FDA approved to lower cholesterol and reduce the risk of heart attacks and strokes, by helping to restore blood flow to the heart in individuals with heart disease. Similar to statins, Repatha is a cholesterol-lowering prescription drug. However, these medications work differently and belong to different drug classes. Statins are the first-line treatment for high cholesterol. If statins alone don’t lower your low-density lipoprotein (LDL) cholesterol levels, or if they cause unpleasant side effects, your provider may recommend Repatha as a treatment option. You can take Repatha alongside statins, such as Lipitor (atorvastatin) or Crestor (rosuvastatin), or on its own because it works differently.

Is Repatha a statin?

No, Repatha is not a statin. Statins work by blocking an enzyme called HMG-CoA reductase, which is involved in cholesterol production in the liver. Repatha works by enhancing the removal of LDL cholesterol from circulation. “Repatha is a PCSK9 inhibitor. PCSK9 is a protein that recycles receptors for the bad cholesterol. When we block this protein, we increase the receptors for the bad cholesterol. When we increase those, more cholesterol can leave the blood,” explains Rigved Tadwalkar, MD, a board-certified cardiologist and medical director of the Cardiac Rehabilitation Center at Providence Saint John’s Health Center in Santa Monica, California.

Because Repatha is in a completely different drug class than statins, it works for people who can’t tolerate statins. “This is my go-to medication when a statin doesn’t work for the patient,” explains Yu-Ming Ni, MD, board-certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. “While I typically prescribe Repatha with a statin, there are some patients—around 9%—that cannot tolerate statins because they have muscle side effects. Repatha works quite well and is one of the most effective cholesterol-reducing medications.” That’s not to say Repatha and other PCSKP inhibitors like Praluent (alirocumab) are better than statins; they just work differently.

Additionally, Repatha can help people whose cholesterol is still high when taking statins. “Repatha is a really important medication because it allows people to lower their dosages of the statins but still lowers their cholesterol,” Dr. Tadwalkar explains. Taking a lower dosage may help to lower your risk of side effects from statins.

While Repatha may be more tolerable than statins in some individuals, the medication is not without side effects and risks.

According to the manufacturer’s prescribing information, common side effects of Repatha include:

• Runny nose, sore throat, and other common cold symptoms
• Flu or flu-like symptoms
• Back pain
• High blood sugar levels
• Redness, pain, or bruising at the injection site

Serious side effects of Repatha that may require hospitalization caused by allergic reactions include:

• Trouble breathing or swallowing
• Raised bumps (hives)
• Rash or itching
• Swelling of the face, lips, tongue, throat or arms

Pregnant or breastfeeding women should consult their healthcare provider before taking Repatha. All patients should let their provider know about any over-the-counter or prescription medications and dietary supplements they are taking to avoid possible interactions.

Repatha vs. statins

Repatha and statins are both cholesterol-lowering medications, but there are some key differences:

• History of use: Repatha is a relatively new medication. It first gained FDA approval in 2015. Statins first gained FDA approval for use in 1987, so they have a much longer history of use.
• Class of medication: Repatha is a type of monoclonal antibody created in a lab to bind to proprotein convertase subtilisin/kexin type 9 (PCSK9). Statins are a class of medication called HMG-CoA reductase inhibitors that block the synthesis of cholesterol.
• Reason prescribed: Repatha is generally prescribed when a person has side effects like joint and muscle pain from statins. Your healthcare provider may also prescribe Repatha when high doses of statins are not effective, you have a high risk of cardiovascular disease, or you cannot tolerate statins. What’s more, research indicates that Repatha can also lower triglycerides (a type of lipid, or fat, found in your blood). However, statins are a first-line treatment, meaning doctors often start with them.
• Medication form: Repatha is an injectable medication that comes in a prefilled syringe. It is given as a subcutaneous injection, typically in the upper arm, upper thigh, or stomach. Statins are an oral medication, in pill form.
• Side effects: Repatha’s most common side effects include injection site reactions and flu-like symptoms for a few days following the injection. Statins are often well-tolerated, but they can cause several potential side effects, including muscle weakness and pain, nausea, diarrhea, fatigue, and headaches.
• Effectiveness: The American Heart Association states that statins are the most recommended medication for people with high cholesterol because they are so effective. Repatha is also effective, especially when combined with a statin. Clinical trials showed a 15% to 20% lower risk of major adverse cardiovascular events (heart attack, stroke) and a 23% lower risk of cardiovascular death in those who took Repatha compared to those who took the placebo over a longer time frame. In one study, researchers found that the use of evolocumab along with statins helped to lower LDL (“bad”) cholesterol by an average of 30 mg per deciliter. This helped to reduce the risk of cardiovascular events, such as heart attack or stroke.
• Reputation: Repatha is a new medication, so it is not as well known. Both Drs. Ni and Dr. Tadwalker generally praise its effectiveness. Statins have a good reputation among healthcare professionals. However, many patients fear muscle and joint pain, even though the side effect only happens to a small percentage of those taking it. In fact, 2019 study found that a leading cause of people not taking statins—even when recommended by a doctor—is concerns over possible side effects.

Repatha and statins together

Repatha and statins are frequently prescribed together either for people at high risk for cardiovascular events or in those whose cholesterol levels do not lower with statins alone.

Dr. Tadwalkar says “We use them together because they are complementary and can be remarkably effective in working together since they have different mechanisms.” Indeed, one study noted that using both medications together worked very well in reducing cholesterol.

Discontinuation concerns and alternatives

On June 30th, 2024, Amgen (the manufacturer of Repatha) discontinued the Repatha Pushtronex® System. However, the company continues to provide the Repatha® SureClick® Autoinjector. The decision had nothing to do with the effectiveness or safety of Repatha.

This may have spurred rumors that Amgen would stop making Repatha. However, there is no publicly available information about the potential discontinuation of the medication.

Dr. Ni hopes these rumors that Repatha may be discontinued are just rumors. “It would be a tragedy if it does get discontinued. Repatha is a fantastic medication that has been used for a long time, and it would change things for the way I practice.”

Dr. Tadwalkar also thinks it is unlikely that Repatha will be discontinued, saying, “PCSK9 inhibitors, like Repatha, have a critical role in managing cholesterol, especially in high-risk populations. Some of the things we are doing with cholesterol, we’d never be able to do without medications like Repatha, so I think it or something like it is here to stay.” In other words, he finds that he can help his patients lower their cholesterol using Repatha when other methods—including diet and other medications—do not work for them.

Drug class	How it works	Coupons
Cholesterol absorption inhibitors	The only medication designed to stop the intestine from absorbing cholesterol	Ezetimibe coupons
Bile acid sequestrants	Help the intestines get rid of more cholesterol	Cholestyramine coupons
		Colesevelam coupons
		Colestipol coupons
Adenosine triphosphate-citrate lyase (ACLY) inhibitors	Work by helping to prevent the liver from making cholesterol	Bempedoic acid coupons
Fibrates	Help to reduce overall fat levels	Lopid (gemfibrozil) coupons
		Tricor (fenofibrate) coupons
Omega-3 fatty acid ethyl esters	A compound used with diet to help lower cholesterol levels	Omega-3 coupons
B vitamins	Help prevent the production of blood fats in the liver	Niacin (nicotinic acid)

These medications and supplements work differently than Repatha and have different levels of effectiveness and side effects. Currently, the most commonly prescribed non-statin is ezetimibe, likely due to its overall effectiveness and general safety. A healthcare provider can best determine which is right to use.

The bottom line

Repatha is a type of PCSK9 inhibitor that helps the liver remove bad cholesterol. It is typically used as a second-line therapy in people whose cholesterol levels don’t improve enough with statins or for those who can’t tolerate statins. If you find you do not tolerate a medication, seek medical advice from your healthcare provider before changing how and when you take it.