Leqvio and Repatha are both injectable medicines that are used for the treatment of high cholesterol and their action is to specifically lower low density lipoprotein (HDL) cholesterol levels. Although they are both inhibit a protein called PCSK9 they work by different mechanisms. Repatha is a monoclonal antibody that binds directly to PCSK9 in the liver preventing it from binding to LDL receptors. Leqvio blocks the PCSK9 protein by interfering with the translation of PCSK9 messenger RNA. Both have the same result – and that is freeing up LDL receptors on the surface of liver cells which allows LDL cholesterol to be removed from the blood.

Both are approved to treat high LDL levels caused by a genetic condition called heterozygous familial hypercholesterolemia (HeFH) but Leqvio can only be used in adults whereas Repatha may be given to adults and children aged 10 years and older with the condition.

• Leqvio is also approved for use in people with atherosclerotic cardiovascular disease (ASCVD) – a condition where the arteries narrow due to a build-up of plaque
• Repatha can also be given to people who have had a stroke or heart attack to reduce their risk of having another, and to adults and children over the age of 13 with another genetic condition that causes high LDL levels called homozygous familial hypercholesterolemia.

Both are injected subcutaneously – which means just under the skin but you can learn to inject Repatha yourself so you can self-administer it at home, but Leqvio needs to be administered by a health professional. Repatha is given every 2 to 4 weeks but Leqvio only needs to be given twice a year (every 6 months) after an initial loading dose of 2 injections, 3 months apart.

LDL cholesterol is only one of the major lipids and apolipoproteins that are relevant in cardiovascular disease which means both Leqvio and Repatha are usually given in addition to other cholesterol-lowering medicines that target triglycerides, such as statins. They both also should be administered in conjunction with lifestyle changes including a cholesterol-lowering diet and a weight management plan. Regular exercise is also important as well as avoiding smoking.

Neither Leqvio nor Repatha have any reported drug interactions and are not expected to be affected by inhibitors or inducers of cytochrome p450 enzymes or transporters.

*After an initial course of 2 injections, 3 months apart