Understanding the Lenacapavir Dosing Schedule
Lenacapavir, marketed as Sunlenca for HIV treatment and Yeztugo for PrEP, features a long-acting dosing schedule with an initiation and a maintenance phase. The initial phase uses both oral tablets and subcutaneous injections to achieve therapeutic drug levels, while the maintenance phase consists of bi-annual subcutaneous injections. The specific initiation schedule varies based on whether it is for treatment or prevention.
Lenacapavir for HIV-1 Treatment (Sunlenca)
For adults with multidrug-resistant HIV, two initiation options are available for Sunlenca before the bi-annual maintenance schedule. Detailed information on the specific schedules can be found on the {Link: SUNLENCA® (lenacapavir) Dosing Information website https://www.sunlenca.com/dosing} and {Link: SUNLENCA® (lenacapavir) Dosing and Administration website https://www.sunlencahcp.com/dosing-and-administration/sunlenca-dosing/}.
Lenacapavir for HIV-1 Pre-Exposure Prophylaxis (PrEP) (Yeztugo)
For HIV prevention, the Yeztugo schedule is standardized. The initiation phase involves doses on Day 1 and Day 2. The maintenance phase follows, with injections given every 6 months (26 weeks) ±2 weeks. More details can be found on the {Link: Lenacapavir for PrEP | Dosing & Administration Gilead ... website https://www.askgileadmedical.com/len4prep/dosing-admin/} and {Link: Interim Guideline on the Use of Twice-Yearly Lenacapavir for ... website https://www.hivguidelines.org/guideline/hiv-prep-len/}.
Comparison of Lenacapavir Schedules
| Feature | HIV-1 Treatment (Sunlenca) | HIV-1 PrEP (Yeztugo) |
|---|---|---|
| Indication | Heavily treatment-experienced adults with multidrug-resistant HIV-1 | Adults and adolescents (>35 kg) at risk for sexually acquired HIV-1 |
| Initiation | Two options: a 2-day or a 15-day regimen involving oral tablets and one initial SC injection. | A 2-day regimen involving oral tablets and one initial SC injection. |
| Maintenance | SC injection every 6 months (26 weeks ± 2 weeks). | SC injection every 6 months (26 weeks ± 2 weeks). |
| Use of other meds | Must be used with other antiretroviral(s). | Used alone for prevention. |
What to do if you miss a dose
Missing a dose can impact effectiveness and increase the risk of resistance. Consult a healthcare provider if a maintenance injection is missed. For information on planned delays with oral bridging or unplanned/prolonged delays, refer to the {Link: SUNLENCA® (lenacapavir) Dosing and Administration website https://www.sunlencahcp.com/dosing-and-administration/sunlenca-dosing/}.
How Lenacapavir's Long-Acting Schedule Works
As a first-in-class HIV-1 capsid inhibitor, lenacapavir targets the virus's outer shell. Its long half-life and mechanism allow for infrequent dosing. The subcutaneous injection creates a depot that slowly releases the drug over six months, maintaining therapeutic levels for viral suppression or protection.
Important Considerations for the Lenacapavir Schedule
- Prior HIV Test: Before starting lenacapavir for PrEP, a negative HIV-1 test, including testing for acute or primary infection, is required.
- Other Medications: For treatment, lenacapavir must be used with other antiretroviral drugs. For PrEP, it's used alone but doesn't prevent other STIs.
- Drug-Drug Interactions: Lenacapavir can interact with other medications, particularly strong or moderate CYP3A inducers. A healthcare provider should review all current medications.
- Healthcare Administration: All subcutaneous injections must be given by a healthcare provider.
Conclusion: The Impact of a Bi-Annual Schedule
The twice-yearly injection schedule of lenacapavir offers a significant advantage in HIV management by improving adherence compared to daily oral medications. This has the potential to enhance outcomes for those with multidrug-resistant HIV and increase PrEP uptake. However, consistent adherence, proper handling of missed doses, and regular consultation with a healthcare provider are vital for effectiveness and preventing resistance.
