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lenacapavir (Sunlenca, Yeztugio)

Indications: - multi-drug resistant HIV1 infection - combined with other antiretroviral agents - use in combination with islatravir for once weekly treatment of HIV1 infection [5] - HIV1 pre-exposure prophylaxis (investigational) [2,3]* * incidence of HIV1 infection in cisgender women 0/100 person-years [3,4] Dosage: - given both orally & by subcutaneous injection (SQ) every 6 months - start: 2 subcutaneous injections 927 mg & 2 days of overlapping oral daily pills (2 300-mg tablets daily) - 2 SQ injections every 6 months, within 14 days before or after the target date - longer delays should be bridged with 300 mg of oral lenacapavir weekly - when reinitiating lenacapavir injections after a delay > 14 days without bridging, the 2-day oral overlap is recommended (see above) * SQ injections administered in the abdomen, anterior thigh, upper gluteus, or posterior upper arm Mechanism of action: - HIV1 capsid inhibitor Notes: - estimated cost $42,250 in the first year of treatment - therafter $39,000 annually in the subsequent years

Interactions

drug adverse effects of antiretroviral agents

General

antiretroviral agent

Database Correlations

PUBCHEM correlations

References

  1. Hick L FDA Approves First-in-Class Drug for HIV Medscape. December 22, 2022 https://www.medscape.com/viewarticle/986049
  2. NEJM Journal Watch. July 30, 2024 2024 International AIDS Conference (results of the PURPOSE-1 study)
  3. Bekker L-G et al. Twice-yearly lenacapavir or daily F/TAF for HIV prevention in cisgender women. N Engl J Med 2024 Jul 24; [e-pub]. PMID: 39046157 https://www.nejm.org/doi/10.1056/NEJMoa2407001 - Walensky RP, Baden LR. The real PURPOSE of PrEP - effectiveness, not efficacy. N Engl J Med 2024 Jul 24; [e-pub]. PMID: 39046168 https://www.nejm.org/doi/10.1056/NEJMe2408591
  4. Yamey G, Machingaidze S. Lenacapavir: a giant step forward in HIV prevention-but a missed opportunity for achieving equity and access. BMJ. 2024 Oct 14;387:q2254. doi: 10.1136/bmj.q2254. PMID: 39401824
  5. Colson AE, Crofoot GE, Ruane PJ et al Once-Weekly Oral Islatravir Plus Lenacapavir Versus Daily Oral Bictegravir, Emtricitabine, and Tenofovir Alafenamide in Persons With HIV-1 : A Phase 2 Randomized Study. Ann Intern Med. 2025 Dec 23. PMID: 41429026

Component-of

islatravir/lenacapavir