Inclisiran
LEQVIO
Pronunciation: in-kli-SIR-an
“Lek, Incli(ned), ran”
-siran = small interfering RNA
Twi'lek species from Star Wars
Pesky K-9 → PCSK9, which targets LDL receptors for destruction
What it issiRNA silencing hepatic PCSK9 synthesis; ASCVD or familial hypercholesterolemia needing more LDL lowering.
Why this oneClinic-given injection twice yearly after loading builds in adherence; LDL lowering approaches PCSK9 antibodies.
What limits itOutcome benefit less established than with evolocumab or alirocumab; requires clinic administration.
Pearls
- Dosed day 0, month 3, then every 6 months.
FDA-approved for
- ASCVD / HeFH — LDL-C lowering (2021)
Principal riskHypersensitivity reactions
Classes and tags
Clinical profile
Legacy pregnancy categoryN/A (post-2015 labeling)
Defining liabilityInjection reactions and rare serious hypersensitivity
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypercholesterolemia / LDL-C lowering (incl. HeFH; adjunct to diet ± other LDL-C-lowering therapies) | Adults | 284 mg SC (abdomen, upper arm, or thigh) once, then again at 3 months | 284 mg SC every 6 months thereafter | 284 mg per dose |
| HeFH or HoFH (adjunct to diet and other LDL-C-lowering therapies) | Peds ≥12 yr | 284 mg SC once, then again at 3 months | 284 mg SC every 6 months thereafter | 284 mg per dose |
Renal No adjustment needed (mild, moderate, or severe impairment; not studied in end-stage renal disease)
Hepatic No adjustment needed (mild to moderate impairment; not studied in severe impairment)
Missed dose <3 months late: administer and keep original schedule; >3 months late: restart schedule (initial dose, again at 3 months, then q6 months)
Instructions
- Administered by a healthcare professional; SC injection into abdomen, upper arm, or thigh
- Do not inject into areas of active skin disease or injury (sunburn, rash, inflammation, infection)
- Inspect visually: clear, colorless to pale yellow; do not use if particulates or discoloration
- LDL-C may be assessed as early as 30 days after initiation, anytime without regard to dose timing
Available strengths
- inj 284 mg/1.5 mL
Cautions
- Hypersensitivity reactions incl. anaphylaxis and angioedema reported; contraindicated after prior serious hypersensitivity reaction — advise patients on signs/symptoms and to seek prompt medical attention
Adverse reactions
- Injection site reaction (8%: pain, erythema, rash)
- Arthralgia
- Bronchitis
- Postmarketing: anaphylaxis, angioedema
Pregnancy Discontinue when pregnancy is recognized (or consider ongoing therapeutic needs); may cause fetal harm based on mechanism (LDL-C lowering); no human data; no adverse developmental effects in animals at 5–10x MRHD
Lactation No human data; present in rat milk, but oligonucleotides have poor oral bioavailability — adverse infant impact considered unlikely; weigh benefits against risk
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 284 mg/1.5 mL | inj | per unit | not offered |
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Memory aids: interaction avatars
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Self-check
- How often are inclisiran maintenance doses given?
Every six months. - About how much does inclisiran lower LDL-C?
50%.