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# ANGPTL3 inhibitors

Drugs that neutralise ANGPTL3, a liver protein that brakes lipases. They lower LDL without needing LDL receptors, so they help homozygous FH.

Updated Nov 12, 2026

## What they are

Evinacumab, a monoclonal antibody given by monthly infusion, is the member in use. It is added to other lipid-lowering treatment in homozygous familial hypercholesterolaemia, where statins and PCSK9 inhibitors work poorly because LDL receptors are absent or barely work. Lomitapide (an MTP inhibitor) is the other LDL-receptor-independent option in this disease.

## Mechanism of action

ANGPTL3 (angiopoietin-like protein 3), made in the liver, inhibits lipoprotein lipase and endothelial lipase. Neutralising it frees these lipases, so triglyceride-rich lipoproteins are broken down faster and less LDL is formed. LDL cholesterol falls by a route that does not depend on LDL receptors.

Target: Angiopoietin-like protein 3 (ANGPTL3)

## Key points

- They lower LDL without LDL receptors: useful in homozygous familial hypercholesterolaemia.
- Evinacumab is a monthly intravenous infusion; infusion and allergic reactions, including anaphylaxis, are the key risks.
- Possible fetal harm: pregnancy testing and effective contraception during and for months after treatment.
- Used on top of diet, statins, ezetimibe, PCSK9 inhibitors or apheresis, not instead of them.

## Drugs in this class

- [**Evinacumab** A monoclonal antibody against ANGPTL3 that lowers LDL cholesterol even without LDL receptors. Monthly infusion for… Angiopoietin-like protein 3 (ANGPTL3), a circulating inhibitor of lipoprotein and endothelial lipases](https://durgical.com/en/pharmacology/evinacumab/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which enzymes does ANGPTL3 normally inhibit?

Lipoprotein lipase and endothelial lipase.

## Why do ANGPTL3 inhibitors work in homozygous FH?

They lower LDL by a pathway that does not need LDL receptors.

## What is the main acute risk during an evinacumab infusion?

Infusion reactions and serious allergic reactions, including anaphylaxis.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Evinacumab-dgnb Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a621023.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C10AX17) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/angptl3-inhibitors/