INTRODUCTION: Despite the proven efficacy of statins, they are often reported to 
be inadequate to achieve low-density lipoprotein cholesterol (LDL-C) goals 
(especially in high-risk patients). Moreover, a large number of subjects cannot 
tolerate statins or full doses of these drugs. Thus, there is a need for 
additional effective LDL-C reducing agents.
AREAS COVERED: Evolocumab (AMG145) is a monoclonal antibody inhibiting the 
proprotein convertase subtilisin/kexin type 9 that binds to the liver LDL 
receptor and prevents it from normal recycling by targeting it for degradation. 
Phase I and II trials revealed that its subcutaneous injection, either alone or 
in combination with statins, is able to reduce LDL-C from 40 to 80%, 
apolipoprotein B100 from 30 to 59% and lipoprotein(a) from 18 to 36% in a 
dose-dependent manner. The incidence of side effects seems to be low and mainly 
limited to nasopharyngitis, injection site pain, arthralgia and back pain.
EXPERT OPINION: Evolocumab is an innovative powerful lipid-lowering drug, 
additive to statins and with an apparently large therapeutic range associated to 
a low rate of mild adverse events. If available data will be confirmed in 
long-term trials with strong outcomes, Evolocumab will provide an essential tool 
to treat high-risk patients who need to reach ambitious LDL-C target.