Evinacumab
ANGPTL3 inhibitors
ANGPTL3 inhibitorsPregnancy: avoid
Avoided in pregnancy: it may harm the fetus, so a pregnancy test may be done and effective contraception is used during treatment and for months after the last dose.
A monoclonal antibody against ANGPTL3 that lowers LDL cholesterol even without LDL receptors. Monthly infusion for homozygous familial hypercholesterolaemia.
Quick facts
- Group
- ANGPTL3 inhibitors
- Target
- Angiopoietin-like protein 3 (ANGPTL3), a circulating inhibitor of lipoprotein and endothelial lipases
- Key effects
- Runny or stuffy nose · Dizziness
- Monitor
- LDL cholesterol and lipid profile
- ATC
- C10AX17
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows the fibrinogen-like domain of human ANGPTL3; the antibody itself is not in this structure.
ANGPTL3, made in the liver, inhibits lipoprotein lipase and endothelial lipase. Evinacumab is a fully human monoclonal antibody that binds and neutralises ANGPTL3. The lipases become more active, so triglyceride-rich lipoproteins are broken down faster and fewer remnants become LDL; LDL cholesterol falls by a pathway that does not need LDL receptors. That is why it works in homozygous familial hypercholesterolaemia, where LDL receptors are absent or barely work.
- Antibody binds and neutralises ANGPTL3
- Lipoprotein and endothelial lipases are released from inhibition
- Triglyceride-rich particles are cleared; less LDL forms
- LDL falls without needing LDL receptors
Indications
- Homozygous familial hypercholesterolaemia, added to other lipid-lowering treatment Familial hypercholesterolemia →
Adverse effects
Common
- Runny or stuffy nose, sore throat, flu-like symptoms
- Dizziness, nausea
- Pain in arms or legs
- Tiredness or weakness
Contraindications
- History of serious hypersensitivity to evinacumab
Key interactions
- Other lipid-lowering drugs (statins, ezetimibe, PCSK9 inhibitors, apheresis)
- Used together as background therapy.
What is monitored
- LDL cholesterol and lipid profile
- Infusion and allergic reactions
- Pregnancy test before starting when relevant
Administration and safety
- Slow intravenous infusion in a health-care setting every four weeks.
- The infusion is slowed or stopped for an infusion reaction.
- A low-fat, low-cholesterol diet and other lipid-lowering treatment continue.
Pregnancy and breastfeeding
Avoided in pregnancy: it may harm the fetus, so a pregnancy test may be done and effective contraception is used during treatment and for months after the last dose.
Nursing care
- Before: check allergies, baseline lipids and pregnancy status.
- During: watch for itching, rash, swelling or breathing difficulty.
- Teach to report symptoms of an allergic reaction after the infusion.
- Remind about missed infusions and diet.
Pharmacokinetics
- Absorption
- Intravenous infusion over about an hour, every four weeks.
Test yourself
Think of the answer, then tap the question to see it.
What does ANGPTL3 normally do?
It inhibits lipoprotein lipase and endothelial lipase.
Why does evinacumab work in homozygous FH when statins barely do?
It lowers LDL by a pathway that does not depend on LDL receptors.
How is evinacumab given?
As an intravenous infusion every four weeks.
Connections
← Back to the class: ANGPTL3 inhibitors
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 (MedlinePlus (U.S. National Library of Medicine), 2025); The fibrinogen-like domain of human Angptl3 (RCSB Protein Data Bank, 2018); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.