Evolocumab
PCSK9 inhibitor — monoclonal antibody · “The FH rescue injection”
The Clinical Case
Male, 34 yo. Heterozygous familial hypercholesterolaemia confirmed genetically. On rosuvastatin 40 mg + ezetimibe — LDL still 4.8 mmol/L. Tendon xanthomas present, father had MI at 42. Lipidologist adds a SC injection targeting PCSK9 directly, available every 2 weeks or monthly, expected to drive LDL below 1.4 mmol/L. FOURIER trial evidence cited.
The Answer
Played on: 11 Jan 2026 · 25 Jan 2026 · 8 Feb 2026 · 22 Feb 2026 · 8 Mar 2026 · 22 Mar 2026 · 5 Apr 2026 · 19 Apr 2026 · 3 May 2026 · 17 May 2026 · 31 May 2026 · 14 Jun 2026 · 28 Jun 2026 · 12 Jul 2026 · 26 Jul 2026 · 9 Aug 2026 · 23 Aug 2026
Clinical Pearl
Mechanism: Human IgG2 mAb binds PCSK9 — prevents LDL receptor degradation → recycled receptors → LDL↓ 50–65% on top of statin
All Hints
Mechanism: Human IgG2 mAb binds PCSK9 — prevents LDL receptor degradation → recycled receptors → LDL↓ 50–65% on top of statin
FH: Approved for heterozygous and homozygous FH (residual LDL-R activity required for full efficacy)
Dosing: 140 mg SC q2w OR 420 mg SC once monthly — patient preference; pen device, self-administered
FOURIER: 15% RRR MACE; median LDL achieved 0.78 mmol/L — no safety signal at very low LDL levels
Access: Cold-chain storage; biosimilars now available; funded for FH + high-risk statin-intolerant patients
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