Promising new drug Leqvio can lower cholesterol -- but, surprise, it's really expensive

With just one shot every six months, a new drug appears to be able to reduce LDL (bad) cholesterol by 40-50 percent.

What is Leqvio?

Leqvio (or the generic name, inclisiran – say either one of those names three times fast!) uses exciting new biotechnology -- similar to that used for the mRNA COVID vaccines. The drug helps the liver prevent the production of a protein called PCSK9 that keeps cholesterol levels high. The net effect is similar to what Repatha and Praluent do (they essentially act as PCSK9 antibodies to reduce levels of this protein).  But instead of requiring one or two shots a month like Repatha and Praluent, Leqvio's effects last much longer so you only need a couple shots per year.

What are the downsides?

But there’s always a catch when it comes to drugs.

It’s very expensive

For one thing, Leqvio costs $3,250 per dose. Given that a patient needs three doses in the first year followed by two doses each subsequent year -- well, you can do the math.  Given the expense, insurers will use stringent criteria to determine who is eligible to receive this therapy. 

FDA-approved without the results of outcome trials

Second, the drug’s effect on cardiovascular morbidity and mortality is still being investigated. The FDA approved Leqvio without the results of outcome trials.  That’s because lower LDL, regardless of how you get there (including with food), has been consistently shown to be associated with lower event rates.

Potential side effects

Third, no drug is without potential side effects.  Fortunately, in Leqvio’s case these appear to be uncommon but do include joint stiffness, urinary tract infections, diarrhea, bronchitis and difficulty breathing.  Of course the drug is brand new and has not been deployed in very many patients so it's possible that other side effects or unexpected consequences emerge with time.

Finally, the drug isn’t meant to be used as a stand-alone treatment: It’s meant to be used along with statins -- and a heart-healthy diet!

What are the upsides?

Even with all those caveats, this drug’s existence is good news. It could transform the lives of people who eat a healthy diet, take statins at their maximum tolerated levels and still can’t lower their cholesterol.  And, assuming side effects remain rare and minor, getting an injection twice a year is about as low-maintenance as it gets!

I just hope that doctors and patients considering medications -- no matter how innovative or low risk -- remember how crucial it is to take care of the fundamentals like diet.  The importance of a healthy diet is never diminished because a new drug comes along.  After all addressing the root cause of a health problem is the only way you will ever cure it.  For most people, too much PCSK9 is not the reason they have high cholesterol.  For most people high cholesterol is caused in part or in whole by a deficiency of the right foods. 

Who is a candidate for Leqvio?

If you think you’re a candidate for Leqvio, talk to your doctor.  Whether or not you can get your hands on it, Step One is still here to help. Our products have the cholesterol-lowering effects the FDA looks for when it's looking at drugs, and while they do cost more than junk food, the expense is not even comparable to drug prices. Plus we know that all the “side effects” of eating a heart-healthy diet are actually side benefits!

Photo source: Pharmaphorum