Repatha in Diabetics

What Is Repatha?

Repatha (evolocumab) is an antibody that targets a specific protein, called PCSK9. By blocking PCSK9’s ability to work, more receptors are available to get rid of LDL cholesterol from the blood. Consequently, blood leve of LDL cholesterol drops.

Potential Candidates For Repatha

It is approved for use in addition to diet and maximally-tolerated statin therapy in adult patients with heterozygous familial hypercholesterolemia (HeFH), homozygous familial hypercholesterolemia (HoFH), or clinical atherosclerotic cardiovascular disease, such as heart attacks or strokes, who require additional lowering of LDL cholesterol.

The efficacy and safety of Repatha were evaluated in one 52-week placebo-controlled trial and eight 12-week placebo-controlled trials in participants with primary hyperlipidemia, including two that specifically enrolled participants with HeFH and one that enrolled participants with HoFH.

Side-effects of Repatha

The most common side effects of Repatha include nasopharyngitis, upper respiratory tract infection, flu, back pain, and reactions such as redness, pain, or bruising where the injection is given. Allergic reactions, such as rash and hives, have been reported with the use of Repatha. Patients should stop using Repatha and get medical help if they experience symptoms of a serious allergic reaction.

Repatha can drastic reduction in your LDL cholesterol, even to less than 25 mg/dl. Does this drastically low LDL cholesterol level translate into the actual reduction in the cardiovascular events is not established at this time. Long-term side-effects of such low LDL cholesterol on the rest of the body are not known, which is, obviously, of concern.

A Case Report from my Practice:

Recently, a diabetic patient consulted me for a sudden increase in his Blood Glucose levels (into 300-400 range) and severe muscle weakness. He was puzzled with this finding as he had not changed his diet, exercise routine and had not experienced any new stressful situation. Upon questioning, he remembered that he had recently started to take Repatha.

I advised him to stop Repatha. His blood glucose levels came back to his usual (about 120-150) over the next couple of weeks.

Summary:

Repatha is a new drug to lower cholesterol level. It is not for every person who has elevated cholesterol level. It is indicated only in patients with Familial hypercholesterolemia (a familial disorder) and those who have history of heart attack or stroke. Even in these patients, diet and Statin drugs should be tried first. Repatha is indicated if a further reduction in LDL cholesterol is needed.

Repatha has to be taken with injection.

t has a long list of serious side-effects, which will only grow as this drug enters the real world. Repatha can cause severe reduction in LDL cholesterol. The actual benefits as well the long term side-effects of such drastic reduction in the LDL cholesterol levels are unknown at this time.

 

 

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

 

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