Amgen has reported that its human monoclonal antibody Repatha (evolocumab) lowered fatal or non-fatal heart attack risk by 20% in a real-world trial over ezetimibe in patients with atherosclerotic cardiovascular disease (ASCVD).
The study tracked 544,103 adults with prior statin use over a period of up to four years in routine clinical care.
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Conducted using de-identified records from the Komodo Healthcare Map database between 2017 and 2024, the active-comparator cohort study analysed 64,421 patients starting evolocumab alongside 479,682 initiating ezetimibe.
Patient follow-up was conducted through June 2026 to track fatal and non-fatal heart attacks.
Among 225,048 participants with recorded baseline low-density lipoprotein cholesterol levels, the four-year cumulative incidence of heart attacks was 5.88% for evolocumab versus 7.76% for ezetimibe.
For individuals lacking baseline measurements, the corresponding risks were 5.65% and 7.06%, yielding an overall hazard ratio of 0.80 with a 95% confidence interval of 0.70 to 0.91.
Amgen chief medical officer Paul Burton said: “We have known for decades that lowering LDL cholesterol reduces cardiovascular risk, yet many patients with ASCVD cannot reach recommended levels with statins alone.
“For physicians deciding what treatment to add next, whether that’s prescribing patients Repatha or ezetimibe, this large real-world study provides clear evidence to help inform that choice.
“Patients who received Repatha had a 20% lower risk of heart attack or death from a heart attack compared with those who received ezetimibe.”
A prespecified sensitivity analysis tracking patients regardless of statin therapy changes produced consistent results.
Repatha inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9), preventing receptor degradation to clear cholesterol from the blood. Ezetimibe is an oral treatment that reduces cholesterol by limiting absorption.
In April, Amgen reported positive topline results from its Phase III subcutaneous Tepezza (teprotumumab-trbw) trial in adults with moderate-to-severe active thyroid eye disease.
