Nexletol vs. Repatha for High Cholesterol: Important Differences and Potential Risks.

Nexletol

(bempedoic acid)

Repatha

(evolocumab)

Summary for Nexletol

Prescription only

Nexletol (bempedoic acid) is a brand-name medication that treats adults with high cholesterol, including those with a genetic condition called familial hypercholesterolemia. It also helps lower the risk of heart attack and the need for a procedure that opens blocked arteries to help blood flow to the heart in adults at risk for heart disease who aren't taking statins. Nexletol (bempedoic acid) is an ATP-citrate lyase (ACL) inhibitor that lowers LDL-C (low-density lipoprotein cholesterol). Nexletol (bempedoic acid) is a tablet that's taken by mouth once per day. Side effects include having high uric acid levels and muscle spasms.

Indications for Nexletol

Treatment of high cholesterol
Treatment of heterozygous familial hypercholesterolemia (genetic condition that causes high cholesterol)
Lower the risk of heart attack and the need for a heart procedure that opens blocked arteries to help blood flow to the heart (e.g., stent placement) in adults at risk for heart disease

Pros and Cons for Nexletol

Pros

Taken by mouth once per day
Can take by itself, with a statin, or with other cholesterol-lowering medications
Lowers LDL-C (bad cholesterol) by an average of almost 20% after 3 months of taking Nexletol (bempedoic acid) with a statin
Can take if you have mild-to-moderate kidney or liver problems

Cons

Only available as a tablet that can't be crushed
Can raise uric acid levels, which can be a cause of gout
Hasn't been studied in children, so it's not known how safe or how well the medication is for them
No lower-cost generic available; brand name only

Common Side Effects for Nexletol

High uric acid levels (16%)
Kidney problems (11%)
Anemia (low red blood cell count; 5%)
High liver enzyme levels (4%)
Muscle spasms (4%)

Warnings for Nexletol

High uric acid levels
Tendon rupture or injury

Summary for Repatha

Prescription only

Repatha (evolocumab) is a PCSK9 inhibitor that's given as an injection under the skin. It treats high cholesterol in adults and certain children. It works best with a heart-healthy diet and regular exercise. Repatha (evolocumab) also helps lower the risk of events like heart-related death, heart attack, and stroke in adults at risk. The medication is injected either once every 2 weeks or once a month. Side effects can include common cold symptoms and discomfort at the injection site.

Indications for Repatha

High cholesterol in adults
Heterozygous familial hypercholesterolemia (HeFH) in people ages 10 years and older
Homozygous familial hypercholesterolemia (HoFH) in people ages 10 years and older
Lowering the risk of heart-related death, heart attack, stroke, hospitalization for chest pain, and the need for heart procedures in adults at risk

Pros and Cons for Repatha

Pros

Taken once every 2 weeks or once a month
Can use for inherited cholesterol conditions in kids 10 years and up
Has different injection devices to choose from (prefilled syringe, autoinjector, or on-body infusor)

Cons

Must give as an injection under the skin
Might cause reactions at the injection site like redness and pain
Caution use in people with a latex allergy for syringes and autoinjectors (some have parts made with natural rubber)