What’s the difference between Repatha, Praluent, and inclisiran, and are their heart-protection benefits equally established?

Repatha is evolocumab and Praluent is alirocumab. Both are monoclonal antibodies that bind PCSK9 outside cells. Inclisiran, sold as Leqvio, is a small interfering RNA treatment that reduces PCSK9 production inside liver cells. It is therefore not another PCSK9 antibody. All can substantially lower LDL cholesterol, but their dosing schedules, delivery arrangements and duration of action differ. Inclisiran’s infrequent maintenance administration can be useful for adherence, without establishing that it is inherently more protective.[1][2]

Evolocumab reduced cardiovascular events in FOURIER, and alirocumab did so after acute coronary syndrome in ODYSSEY OUTCOMES. Inclisiran’s pivotal lipid trials demonstrated LDL lowering; that result should not be presented as the same evidence as a completed dedicated cardiovascular outcomes trial. The ORION-4 study website still describes its event results as forthcoming at this page’s review date. Comparisons should separate demonstrated LDL reduction, demonstrated event reduction and convenience. There is no basis here to rank all three by a single universal “best” label.[2][3][4][5]