Evolocumab (Repatha) and alirocumab (Praluent): how it works, status and trials

Approved 2015Injected proteinLowering LDL cholesterol

Evolocumab (Repatha) and alirocumab (Praluent) are injections that bind PCSK9, a protein that destroys LDL receptors. With PCSK9 blocked, the receptors survive and keep clearing LDL from the blood.

In technical terms: Bind PCSK9 so it cannot attach to the LDL receptor; receptors recycle to the cell surface instead of being destroyed in lysosomes.

The highlighted badge marks where Evolocumab (Repatha) and alirocumab (Praluent) acts. Open the full map or compare every therapy.

At a glance

Acts on: PCSK9 protein · blood
How it is given: Monoclonal antibody · SC every 2 or 4 weeks
What the main trial found: LDL-C ≈ −60%; Lp(a) −20% to −30%; MACE HR 0.85 (FOURIER, ODYSSEY)
Status (curated October 25, 2026): Approved 2015

Where it fits in the body

The LDL-receptor cycle

LDL particles are cleared from blood when they bind LDL receptors on liver cells. After the particle is taken in, a receptor normally returns to the surface and can be reused many times. PCSK9 escorts the receptor to the lysosome, where it is destroyed. Every PCSK9-pathway drug (5–10) works by keeping more receptors on the surface.

See it on the interactive map

Evidence

FOURIER (PubMed 28304224)
ODYSSEY OUTCOMES (PubMed 30403574)
VESALIUS-CV (PubMed 41211925)

Common questions

How does Evolocumab (Repatha) and alirocumab (Praluent) work?

Evolocumab (Repatha) and alirocumab (Praluent) are injections that bind PCSK9, a protein that destroys LDL receptors. With PCSK9 blocked, the receptors survive and keep clearing LDL from the blood. In technical terms: Bind PCSK9 so it cannot attach to the LDL receptor; receptors recycle to the cell surface instead of being destroyed in lysosomes. It acts on PCSK9 protein · blood.

How much does Evolocumab (Repatha) and alirocumab (Praluent) lower cholesterol or other lipids?

LDL-C ≈ −60%; Lp(a) −20% to −30%; MACE HR 0.85 (FOURIER, ODYSSEY). Individual results differ, and a clinician can say what to expect for one person.

Is Evolocumab (Repatha) and alirocumab (Praluent) approved, and what is the status?

Approved 2015 (curated October 25, 2026).

How is Evolocumab (Repatha) and alirocumab (Praluent) taken?

Monoclonal antibody · SC every 2 or 4 weeks.

Related therapies

Statins: Approved (generic)
Bempedoic acid (Nexletol, Nexlizet): Approved 2020
Ezetimibe (Zetia): Approved (generic)
Bile acid sequestrants (colesevelam): Approved (generic)

Educational, not medical advice. Mechanism and status text curated October 25, 2026; registry data refreshed October 27, 2026. Registries can lag company announcements. Effects are placebo-adjusted results from the main published trial, not head-to-head comparisons. Investigational agents are available only in clinical trials. Preval Health does not practice medicine; licensed clinicians in a partner network provide care. If you have chest pain or signs of a stroke, call 911.