APCU25OS22 Five-year experience with evolocumab (Repatha) at universiti Sains Malaysia: impact of a single dose on LDL-cholesterol reduction

Introduction Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have revolutionized lipid management, particularly in patients with atherosclerotic cardiovascular disease (ASCVD) and suboptimal response to statins or ezetimibe. Despite their proven efficacy, real-world data from Southeast Asia remain limited. We present Universiti Sains Malaysia’s five-year experience with evolocumab (Repatha), focusing on the effect of a single dose on low-density lipoprotein cholesterol (LDL-C) levels.Methods We retrospectively reviewed 101 patients who received at least one dose of evolocumab between 2019 and 2024. Baseline demographics, cardiovascular risk factors, and concomitant lipid-lowering therapies were collected. Lipid profiles were measured at baseline and at follow-up intervals, with particular emphasis on the four-week post-dose measurement to assess the early efficacy of a single administration.Results The cohort included patients with a high prevalence of ischemic heart disease, hypertension, diabetes mellitus, and dyslipidemia. At baseline, the mean LDL-C was 2.5 mmol/L despite optimized background therapy with statins and/or ezetimibe. Following a single subcutaneous dose of evolocumab, the mean LDL-C at 4 weeks decreased to 1.5 mmol/L, representing an approximate 40% reduction. This study shows a sharp LDL-C reduction to below 1 mmol/L after a single Repatha dose and in some cases, approaching near-zero values The early LDL-C lowering effect was sustained with continued therapy at subsequent follow-ups (12, 24, and 84 weeks), though the present analysis focuses on the immediate impact of a single dose. No major safety concerns or adverse events were identified in this early treatment phase.Conclusion In this five-year real-world experience from Universiti Sains Malaysia, a single dose of evolocumab produced a significant and clinically meaningful reduction in LDL-C levels, with nearly 40% reduction at 4 weeks. These findings underscore the rapid efficacy of PCSK9 inhibition in patients with high cardiovascular risk, even after only one administration. This data supports broader utilization of evolocumab in Malaysian clinical practice, especially for patients inadequately controlled on conventional therapy.