Ask the Pharmacist
by Ron & Marla Chapleau
December 14, 2015
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Q) What can you tell me about the new cholesterol medication?
A) Repatha (evolocumab) is the first truly new cholesterol medication to hit the market in many years.
High cholesterol is a massive problem for many Canadians as it can lead to significant increases in sickness and in death if not corrected.
As of 2011, it is estimated that the percentage of Canadians with unhealthy total cholesterol levels ranged from under 35% in those less than 40 years old to 57% in the 40-59 aged group and 44% in those who ranged in age from 60-75 (disturbingly enough, of these individuals, only 25% had been diagnosed with high cholesterol by a health professional).
While cholesterol is important to human health (it is used in the manufacture of vitamin D, certain hormones and helps maintain the structure of our cell membranes)levels that are too high can buildup in our arteries (this is termed plaque) causing them to narrow (atherosclerosis). This narrowing makes it more difficult for blood to flow through to the various parts of your body putting you at risk of heart attacks and strokes if the flow of blood through the constricted vessels becomes too little.
At present, we have a number of excellent medications that can lower our cholesterol levels and prolong our life and our health.
The most notable of these are the statins (Crestor, Lipitor...) which have been amongst the most prescribed classes of drugs in Canada for many years. Unfortunately for some, these drugs just arenít strong enough to reduce the cholesterol to levels that experts believe we need to reduce our risk of further narrowing and hence cardiac events.
For this small subset of people, Repatha presents a powerful new option. Repatha is not meant to replace these other drugs (or a better diet and more exercise of course) but to be added on to them if they are at their maximum allowable (or tolerated without side effects) doses and still not lowering your bad cholesterol (LDL) to the current targets.
Repatha is very impressive when it comes to lowering LDL, proving in studies that it can cause a further 60% reduction when it is added on. Given these dramatic results itís not a surprise that Repatha works in a completely novel manner from our current cholesterol medications.
PCSK9 is an enzyme which glues onto the areas on our liver (specifically LDL receptors) which are responsible for removing some of the LDL which circulates in our blood. By binding to these receptors, the PCSK9 ensures that the liver is less effective at getting rid of our LDL. Repatha counteracts this by partially preventing the PCSK9 from binding to our liver.
Like many new drugs, Repatha is given by a subcutaneous injection (just like insulin is, so that it can be done at home after a limited amount of instruction) either every 2 weeks or once monthly. It comes in a prefilled syringe (so no measuring is required) and can be injected into the usual areas for subcutaneous injections (namely the upper arms, thighs or abdomen).
The most common side effects include what are called mild injection site reactions (this refers to the pain, redness and bruising that any needle can cause to the skin when it is inserted), a runny nose, an increased risk of throat, sinus and chest infections, back pain, joint pain and nausea. Long term safety data is currently lacking which is a significant drawback.
Currently researchers are closely looking at Repatha to see if it elevates a chemical that indicates muscle damage is being done (and subsequently possible kidney damage) or if it will increase our risk of diabetes. It is unknown at this time as to whether these concerns are unfounded or are going to limit our use of this drug in the future.
The other factor that may limit its use is its cost which is over $7800 a year. As it is not currently on the government drug plan (ODB) or Trillium Drug Plan, Repatha will be completely unaffordable for many of those who might benefit from it unless they have private insurance to help cover the costs.
The other major issue with this drug is that, as of yet, we donít know if this large reduction in cholesterol that it causes will actually lead to a reduction in the data that really matters; heart attacks, strokes and deaths. The statins do reduce these and while it seems likely that Repatha will too, researchers would love to see the evidence which can only be provided with time.
Despite these undeniable negatives, Repatha will be a legitimate option for a few patients who are currently at serious risk for a cardiovascular event as those few have known risks for serious health consequences whereas Repathaís side effects are, at this point, mostly hypothetical.
For more information about this or any other health related effects, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and Port Elgin
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Monday, December 14, 2015