Pros and Cons of Lencapavir as PrEP: Gordon Crofoot, MD, PA

Gordon Crofoot, MD, PA, president and principal investigator at The Crofoot Research Center, spoke about the pros and cons of lenacapavir when it was studied in the PURPOSE trials, emphasizing what doctors and patients need to know should it be approved by the FDA for use as pre-exposure prophylaxis (PrEP) for HIV.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

What were some pros and cons of lenacapavir in the PURPOSE trials?

And this drug has major pros and some cons, but the pros are amazing. It makes this a fabulous drug for PrEP. First of all, it's a nice option. We have other PrEP available. We have Truvada, 1 pill once a day. We have Descovy 1 pill once a day. We've got Apretude, an injection intramuscular every 2 months. So we've got multiple options, but nothing [was] 100% effective until we get to lenacapavir. So this is a very nice other option to what we already have, but it's more effective. It's long acting. This is a twice a year injection. And how amazing is a twice a year injection to prevent transmission.

This is a very nice option that's out there. It's long acting. It's longer than any of the other options out there. And being long-acting, you're getting blood levels that are nice and high. So you give 1 injection, that's all you have to do, and you have effective blood level no matter what lifestyle the patient has. There are certain people who don't respond well to Truvada or Descovy. Some people just don't take it regularly. They forget to take it. They just can't remember. So a lot of our Truvada and Descovy studies looking at those drugs for PrEP, we found there wasn't drug in the body at times, because some people miss taking it today, 2 days, 3 days. They didn't take it for a week, and they don't have protection, so they're more likely to get infected with HIV. Partly, [it's] more likely they don't have drug, but they think they might have drug, so they're doing things that might not be as safe as if they were being more careful, but now they're more likely to pick up the virus because they don't have drug in their system. Lenacapavir, you get drug there. More than 6 months you've got drug. It's going to work no matter what the lifestyle is of the patient that's on PrEP right now. My drug users who maybe party more, they're more sexually active, they're at greater risk, but they forget to take a pill every day, or they forget when their last Apretude injection was, don't worry. On lenacapavir, they have drug there constantly.

This is highly effective, it's long acting. There are minimal side effects. This has been a very nice drug to work with. We've been using it for treatment, and we've done a lot of the research on treatment. And I don't have to worry about kidney toxicity, liver toxicity. I don't have to worry about bone density problems like Truvada. It may cause a little nausea. Nausea was the second more likely side effect that people reported, but the nausea wasn't bad, and no one stopped the studies because of nausea. So we're down to 1 major side effect, which is not damage to any body tissue, but the 1 side effect is injection site reactions, and that was a problem when we first started using the drug for treatment, and it has been a side effect that they've looked at very carefully in the PrEP trials, because you have people that don't have an infection, often young people, and if you give them a lot of painful site reactions, they may stop taking it because they don't want to take it. It hurts to get nodules. So that's been significantly looked at in both the PURPOSE 1 and the PURPOSE 2 study. The women in Africa and the men in the United States, they were monitored for injection site reactions. We found ways to really decrease those injection site reactions tremendously going forward. I'm happy to say that 1 of my nurses sort of developed programs using cold packs or ice packs before the injection and after the injection, dramatically decreasing the amount of injection site reactions. So I think those are decreasing and decreasing in studies now and will be less of a problem. There are really minimal side effects.