Rankings / Cardiovascular & Lipids
PCSK9 inhibitors (evolocumab / alirocumab / inclisiran)
CV/Lipid · Monoclonal antibody or siRNA
Tier A
What this is
Reserved historically for familial hypercholesterolemia, statin intolerance, or high-risk secondary prevention with inadequate LDL on maximal statin. Cost has dropped substantially but remains high. Inclisiran's 2x/year dosing is attractive for adherence.
Mechanism
Block PCSK9 (which degrades LDL receptors) — resulting LDL receptor recycling drives circulating LDL-C down 50-60% on top of statin; inclisiran is siRNA silencing PCSK9 mRNA, dosed every 6 months
Dose & route
Evolocumab 140 mg subQ q2wk or 420 mg monthly; alirocumab 75-150 mg subQ q2wk; inclisiran 284 mg subQ at 0, 3 mo, then every 6 mo
Citations
- https://pubmed.ncbi.nlm.nih.gov/28304224/
- https://pubmed.ncbi.nlm.nih.gov/30403574/
- https://pubmed.ncbi.nlm.nih.gov/32302303/
Links go to the source. If a link is dead or you want something re-checked, let me know.
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.