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Evolocumab side effects: what 161,209 FDA adverse event reports show

Evolocumab · Repatha · 1,176 reaction terms · 368,094 drug–reaction co-reports · data 2026-09-14
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Drug class

PCSK9 Inhibitor

FDA label (Established Pharmacologic Class)

Brand names

Repatha

openFDA label

Who reports

161,209 reports · 17% serious · 2,035 with death outcome · 58% female

openFDA FAERS counts, all years, deduplication not applied

Used for

REPATHA is indicated: To reduce the risk of major adverse cardiovascular (CV) events (CV death, myocardial infarction, stroke, unstable angina requiring hospitalization, or coronary revascularization) in adults at increased risk for these events. As an adjunct to diet and exercise to reduce low-density lipoprotein cholesterol (LDL-C) in: adults with hypercholesterolemia.

FDA label, Indications and Usage

What it is

Evolocumab is a human monoclonal immunoglobulin G2 (IgG2) directed against human proprotein convertase subtilisin kexin type 9 (PCSK9). Evolocumab has an approximate molecular weight (MW) of 144 kDa and is produced in genetically engineered mammalian (Chinese hamster ovary) cells.

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled (related wording) 3Likely indication confounding 6Reporting / coding artifact 12Lab value / disease marker 4Not in label — unassessed 15
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,136 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Fractional exhaled nitric oxide increased119291.4
210.4–403.7ROR 291.6 · calibrated p 4e-11 ✓
88.1 EB05 75.6 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=119 · ♀ 0% (drug 58%)not reported in cached trials
Incorrect disposal of product1,683144.8
135.1–155.3ROR 146.3 · calibrated p 6e-9 ✓
68.2 EB05 65.5 · IC025 +6.0
3/3 methods agree
Reporting / coding artifactserious n=165 · 79% consumernot reported in cached trials
Low density lipoprotein decreased726137.2
123.5–152.3ROR 137.8 · calibrated p 1e-8 ✓
66.4 EB05 62.5 · IC025 +5.9
3/3 methods agree
Likely indication confounding
term in indications
serious n=162 · ♀ 28% (drug 58%)not reported in cached trials
Device difficult to use32,925129.9
128.0–131.8ROR 162.9 · calibrated p 2e-9 ✓
64.8 EB05 64.2 · IC025 +6.0
3/3 methods agree
Reporting / coding artifactage-adj. PRR 154.8 · serious PRR 112.9 · 80% consumernot reported in cached trials
Intercepted product administration error2,52062.9
60.0–66.0ROR 63.9 · calibrated p 3e-6 ✓
42.4 EB05 41.1 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=80not reported in cached trials
Low density lipoprotein abnormal19861.7
52.0–73.0ROR 61.7 · calibrated p 4e-6 ✓
41.7 EB05 37.1 · IC025 +5.0
3/3 methods agree
Likely indication confounding
term in indications
serious n=29not reported in cached trials
Drug dose omission by device24,63861.6
60.7–62.5ROR 72.5 · calibrated p 1e-6 ✓
41.8 EB05 41.4 · IC025 +5.4
3/3 methods agree
Not in label — unassessedage-adj. PRR 118.8 · serious n=1,351 · 84% consumernot reported in cached trials
Product communication issue2,72361.0
58.3–63.8ROR 62.0 · calibrated p 3e-6 ✓
41.6 EB05 40.3 · IC025 +5.3
3/3 methods agree
Reporting / coding artifactserious n=223 · 88% consumernot reported in cached trials
Type iia hyperlipidaemia6956.7
42.7–75.3ROR 56.7 · calibrated p 9e-6 ✓
39.1 EB05 32.0 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=67 · ♀ 0% (drug 58%)not reported in cached trials
Blood cholesterol decreased45541.9
37.7–46.6ROR 42.0 · calibrated p 4e-5 ✓
31.7 EB05 29.4 · IC025 +4.8
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=80not reported in cached trials
Computerised tomogram heart abnormal1840.2
23.7–68.3ROR 40.2 · calibrated p 1e-4 ✓
29.9 EB05 20.0 · IC025 +3.3
3/3 methods agree
Not in label — unassessed–not reported in cached trials
Lipoprotein (a) increased6939.2
30.0–51.4ROR 39.2 · calibrated p 8e-5 ✓
30.0 EB05 24.5 · IC025 +4.2
3/3 methods agree
Likely indication confounding
term in indications
serious n=22not reported in cached trials
Lack of administration site rotation5227.3
20.2–36.8ROR 27.3 · calibrated p 6e-4 ✓
22.5 EB05 17.8 · IC025 +3.8
3/3 methods agree
Not in label — unassessed100% consumernot reported in cached trials
Product knowledge deficit9626.6
21.3–33.1ROR 26.6 · calibrated p 6e-4 ✓
22.1 EB05 18.6 · IC025 +4.0
3/3 methods agree
Reporting / coding artifact100% consumernot reported in cached trials
Accidental exposure to product16,80426.2
25.8–26.6ROR 29.1 · calibrated p 3e-4 ✓
21.9 EB05 21.6 · IC025 +4.4
3/3 methods agree
Reporting / coding artifactage-adj. PRR 29.0 · serious PRR 30.2not reported in cached trials
Low density lipoprotein increased1,17023.2
21.8–24.7ROR 23.3 · calibrated p 1e-3 ✓
19.8 EB05 18.8 · IC025 +4.2
3/3 methods agree
Likely indication confounding
term in indications
serious n=209not reported in cached trials
Occupational exposure to product95622.4
21.0–24.0ROR 22.6 · calibrated p 0.001 ✓
19.2 EB05 18.2 · IC025 +4.1
3/3 methods agree
Not in label — unassessed♀ 80% (drug 58%)not reported in cached trials
Product preparation error2,84020.6
19.8–21.4ROR 20.9 · calibrated p 0.002 ✓
17.8 EB05 17.3 · IC025 +4.1
3/3 methods agree
Reporting / coding artifactage-adj. PRR 38.8 · serious n=152 · 87% consumernot reported in cached trials
Device use error4,25018.4
17.8–19.0ROR 18.9 · calibrated p 0.003 ✓
16.2 EB05 15.8 · IC025 +4.0
3/3 methods agree
Reporting / coding artifactage-adj. PRR 30.5 · serious n=305 · 72% consumernot reported in cached trials
Incorrect dose administered by device3,02117.5
16.8–18.1ROR 17.8 · calibrated p 0.003 ✓
15.5 EB05 15.0 · IC025 +3.9
3/3 methods agree
Reporting / coding artifactage-adj. PRR 31.3 · serious n=175not reported in cached trials
Lack of injection site rotation19416.4
14.1–19.0ROR 16.4 · calibrated p 0.005 ✓
14.6 EB05 13.0 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=18 · 75% consumernot reported in cached trials
Wrong technique in product usage process22,36516.1
15.9–16.3ROR 18.5 · calibrated p 0.003 ✓
14.4 EB05 14.2 · IC025 +3.8
3/3 methods agree
Reporting / coding artifactage-adj. PRR 21.9 · serious PRR 16.2not reported in cached trials
Incorrect dose administered by product16615.8
13.5–18.6ROR 15.9 · calibrated p 0.006 ✓
14.2 EB05 12.4 · IC025 +3.5
3/3 methods agree
Reporting / coding artifactserious n=15 · 74% consumernot reported in cached trials
Vascular stent stenosis4415.3
11.2–20.9ROR 15.3 · calibrated p 0.008 ✓
13.5 EB05 10.3 · IC025 +3.1
3/3 methods agree
Not in label — unassessedserious n=44 · 100% clinicianNCT01764633: 2/13,769 (0.0%) on Evolocumab; 3/13,756 (0.0%) control (serious AE)
High density lipoprotein abnormal2314.0
9.1–21.6ROR 14.0 · calibrated p 0.013 ✓
12.1 EB05 8.1 · IC025 +2.6
3/3 methods agree
Lab value / disease marker–not reported in cached trials
Device dispensing error11513.9
11.5–16.9ROR 13.9 · calibrated p 0.010 ✓
12.6 EB05 10.7 · IC025 +3.3
3/3 methods agree
Reporting / coding artifact–not reported in cached trials
Application site mass2713.9
9.4–20.7ROR 13.9 · calibrated p 0.012 ✓
12.1 EB05 8.4 · IC025 +2.7
3/3 methods agree
Not in label — unassessed♀ 0% (drug 58%) · 100% cliniciannot reported in cached trials
Obstructive sleep apnoea syndrome12913.2
11.0–15.8ROR 13.2 · calibrated p 0.012 ✓
11.9 EB05 10.3 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious n=125 · ♀ 12% (drug 58%)NCT03872401: 3/6,125 (0.0%) on Evolocumab; 1/6,122 (0.0%) control (serious AE)
Fear of injection62612.7
11.7–13.8ROR 12.8 · calibrated p 0.013 ✓
11.6 EB05 10.9 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=42not reported in cached trials
Circumstance or information capable of leading to medication error2,87812.1
11.7–12.6ROR 12.3 · calibrated p 0.015 ✓
11.2 EB05 10.8 · IC025 +3.4
3/3 methods agree
Not in label — unassessedage-adj. PRR 6.9 · serious n=55not reported in cached trials
Myoglobin blood increased12311.3
9.4–13.5ROR 11.3 · calibrated p 0.022 ✓
10.3 EB05 8.8 · IC025 +3.0
3/3 methods agree
Lab value / disease markerserious n=123 · ♀ 0% (drug 58%)not reported in cached trials
Product storage error6,67610.8
10.5–11.1ROR 11.2 · calibrated p 0.021 ✓
10.0 EB05 9.8 · IC025 +3.3
3/3 methods agree
Reporting / coding artifactage-adj. PRR 9.9 · serious PRR 14.2not reported in cached trials
Injury associated with device1,46910.2
9.7–10.7ROR 10.3 · calibrated p 0.030 ✓
9.5 EB05 9.1 · IC025 +3.2
3/3 methods agree
Not in label — unassessedage-adj. PRR 13.0 · serious n=74not reported in cached trials
High density lipoprotein increased669.3
7.2–11.9ROR 9.3 · calibrated p 0.045 ✓
8.4 EB05 6.8 · IC025 +2.6
3/3 methods agree
Lab value / disease markerserious n=14not reported in cached trials
Blood triglycerides decreased229.0
5.8–13.8ROR 9.0 · calibrated p 0.057
7.5 EB05 5.1 · IC025 +2.1
3/3 methods agree
Lab value / disease marker–not reported in cached trials
Percutaneous coronary intervention188.7
5.4–14.1ROR 8.7 · calibrated p 0.064
7.1 EB05 4.6 · IC025 +2.0
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=18NCT01764633: 3/13,769 (0.0%) on Evolocumab; 1/13,756 (0.0%) control (serious AE)
Rhinorrhoea (runny nose)3,6347.7
7.5–8.0ROR 7.9 · calibrated p 0.070
7.3 EB05 7.1 · IC025 +2.8
3/3 methods agree
Not in label — unassessedage-adj. PRR 6.8 · serious PRR 8.8not reported in cached trials

Clinical concept groups

MedDRA splits one clinical problem across several terms (e.g. "neutropenia", "neutrophil count decreased", "agranulocytosis"), which dilutes term-level signals. These rows count reports with any term in a concept group (an exact union, not a sum), compared with all other drugs. Groups are hand-built and listed in the methods.

ConceptReportsPRR 95% CIReading
Hyperglycaemia / diabetes2,5841.00.9–1.0no difference
Rhabdomyolysis / myopathy5360.90.8–0.9lower than other drugs
Myocardial infarction1,3280.80.8–0.9lower than other drugs
Tendon disorder2080.70.6–0.8lower than other drugs
Stroke1,0660.60.5–0.6lower than other drugs
Pancreatitis2560.40.4–0.5lower than other drugs
Arrhythmia / qt6140.40.4–0.4lower than other drugs
Fall / fracture1,0720.40.3–0.4lower than other drugs
Hypoglycaemia2450.30.3–0.4lower than other drugs
Opportunistic infection3410.30.3–0.4lower than other drugs
Serious infection1,7660.30.3–0.3lower than other drugs
Depression5950.30.3–0.3lower than other drugs
Heart failure3640.30.2–0.3lower than other drugs
Anaphylaxis / angioedema2540.30.2–0.3lower than other drugs
Liver injury6090.30.2–0.3lower than other drugs
Malignancy5760.20.2–0.2lower than other drugs

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Evolocumab as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (3 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Device difficult to use32,925129.9
128.0–131.8ROR 162.9 · calibrated p 2e-9 ✓
64.8 EB05 64.2 · IC025 +6.0
3/3 methods agree
Reporting / coding artifactage-adj. PRR 154.8 · serious PRR 112.9 · 80% consumernot reported in cached trials
Drug dose omission by device24,63861.6
60.7–62.5ROR 72.5 · calibrated p 1e-6 ✓
41.8 EB05 41.4 · IC025 +5.4
3/3 methods agree
Not in label — unassessedage-adj. PRR 118.8 · serious n=1,351 · 84% consumernot reported in cached trials
Wrong technique in product usage process22,36516.1
15.9–16.3ROR 18.5 · calibrated p 0.003 ✓
14.4 EB05 14.2 · IC025 +3.8
3/3 methods agree
Reporting / coding artifactage-adj. PRR 21.9 · serious PRR 16.2not reported in cached trials
Accidental exposure to product16,80426.2
25.8–26.6ROR 29.1 · calibrated p 3e-4 ✓
21.9 EB05 21.6 · IC025 +4.4
3/3 methods agree
Reporting / coding artifactage-adj. PRR 29.0 · serious PRR 30.2not reported in cached trials
Product storage error6,67610.8
10.5–11.1ROR 11.2 · calibrated p 0.021 ✓
10.0 EB05 9.8 · IC025 +3.3
3/3 methods agree
Reporting / coding artifactage-adj. PRR 9.9 · serious PRR 14.2not reported in cached trials
Back pain5,5873.2
3.1–3.3ROR 3.3 · calibrated p 0.548
3.1 EB05 3.1 · IC025 +1.6
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 2.7 · serious PRR 3.9NCT01764633: 30/13,769 (0.2%) on Evolocumab; 30/13,756 (0.2%) control (serious AE)
Myalgia (muscle pain)5,4194.3
4.1–4.4ROR 4.4 · calibrated p 0.316
4.1 EB05 4.1 · IC025 +2.0
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 3.4 · serious PRR 5.8NCT01764633: 1/13,756 (0.0%) control (serious AE)
Drug dose omission4,9293.9
3.8–4.0ROR 4.0 · calibrated p 0.377
3.8 EB05 3.7 · IC025 +1.9
3/3 methods agree
Reporting / coding artifactage-adj. PRR 5.4 · serious PRR 2.6not reported in cached trials
Device use error4,25018.4
17.8–19.0ROR 18.9 · calibrated p 0.003 ✓
16.2 EB05 15.8 · IC025 +4.0
3/3 methods agree
Reporting / coding artifactage-adj. PRR 30.5 · serious n=305 · 72% consumernot reported in cached trials
Arthralgia (joint pain)4,0611.3
1.2–1.3ROR 1.3 · calibrated p 0.497
1.3 EB05 1.2 · IC025 +0.3Labeled adverse reaction
exact term
age-adj. PRR 1.2 · serious PRR 2.2NCT01764633: 16/13,769 (0.1%) on Evolocumab; 18/13,756 (0.1%) control (serious AE)
Fatigue (tiredness)4,0590.7
0.7–0.7ROR 0.7 · calibrated p 0.115
0.7 EB05 0.7 · IC025 -0.6
PRR-only: not supported by EBGM or IC
Labeled adverse reaction
exact term
age-adj. PRR 0.6 · serious PRR 1.3NCT01764633: 2/13,769 (0.0%) on Evolocumab; 4/13,756 (0.0%) control (serious AE)
Off label use (used outside approved label)3,9360.6
0.6–0.6ROR 0.6 · calibrated p 0.076
0.6 EB05 0.6 · IC025 -0.8
PRR-only: not supported by EBGM or IC
Reporting / coding artifactage-adj. PRR 0.5 · serious PRR 0.6not reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Evolocumab?

In FDA FAERS, the most frequently co-reported reaction terms for Evolocumab are drug dose omission by device, injection site pain, back pain, myalgia, injection site bruising, arthralgia. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Evolocumab have an FDA boxed warning?

No. The FDA label retrieved for Evolocumab has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Evolocumab causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.