MedPath

Cabotegravir

Generic Name
Cabotegravir
Brand Names
Apretude, Vocabria
Drug Type
Small Molecule
Chemical Formula
C19H17F2N3O5
CAS Number
1051375-10-0
Unique Ingredient Identifier
HMH0132Z1Q
Background

Cabotegravir, or GSK1265744, is an HIV-1 integrase inhibitor that is prescribed with the non-nucleoside reverse transcriptase inhibitor, rilpivirine. Early research into cabotegravir showed it had lower oral bioavailability than dolutegravir, which resulted in the development of long acting monthly intramuscular injection formulation for cabotegravir.

Cabotegravir was granted FDA approval on 21 January 2021 in combination with rilpivirine to treat HIV-1 infection in virologically suppressed individuals. While previously administered once monthly only, this combination product was granted FDA approval for dosing every two months on February 01, 2022 and without the need for an oral lead-in period prior.

Indication

Oral cabotegravir is indicated in combination with rilpivirine for the short-term treatment of HIV-1 in virologically suppressed adults with no history of treatment failure to assess tolerability of cabotegravir or who have missed an injected dose of cabotegravir. Intramuscular extended-release cabotegravir in combination with rilpivirine is indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 years of age and older weighing at least 35 kg to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine.

An extended-release injectable suspension formulation of cabotegravir is also indicated for the prevention of sexually-acquired HIV-1 infection (i.e. for pre-exposure prophylaxis, PrEP) in at-risk adults and adolescents weighing at least 35kg.

Associated Conditions
Human Immunodeficiency Virus Type 1 (HIV-1), Human Immunodeficiency Virus Type 1 (HIV-1) Infection
Associated Therapies
Oral Therapies

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ViiV Healthcare Showcases Long-Acting HIV Innovations and Pipeline Advances at CROI 2025

• Real-world data presented at CROI 2025 demonstrates zero HIV acquisitions and high persistence with Apretude (cabotegravir LA) for PrEP across diverse populations, reinforcing its effectiveness in HIV prevention. • Long-term follow-up data from multiple studies confirms the sustained efficacy and safety of Cabenuva (cabotegravir + rilpivirine LA) as a complete treatment regimen for people living with HIV. • Late-breaking phase IIb data reveals promising results for an investigational broadly neutralizing antibody (VH3810109) in combination with cabotegravir LA, potentially expanding long-acting treatment options.

Quebec Leads Canada in HIV Prevention: First to Cover Long-Acting Injectable PrEP APRETUDE

• Quebec becomes the first Canadian province to provide public reimbursement for APRETUDE, a long-acting injectable HIV prevention drug, through RAMQ coverage for at-risk individuals. • Real-world studies demonstrate over 99% effectiveness of APRETUDE for HIV prevention in nearly 1,300 individuals, showing superior efficacy compared to daily oral alternatives. • The decision comes as HIV cases in Quebec have surged 37% between 2019 and 2022, marking a significant step forward in addressing the rising infection rates.

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European Commission Approves Vocabria + Rekambys for HIV Treatment in Adolescents

• The European Commission has authorized Vocabria in combination with Rekambys for treating HIV-1 in adolescents aged 12 and older who are virologically suppressed. • This long-acting injectable regimen reduces the treatment burden from 365 daily pills to as few as six injections per year. • Clinical trials, including the MOCHA study, showed high rates of virologic suppression and a strong preference for the injectable regimen among adolescents. • The approval marks a significant step in providing more convenient and less stigmatizing treatment options for young people living with HIV.

FDA Grants Breakthrough Therapy Designation to GSK's Jemperli for Advanced Rectal Cancer

• The FDA granted Breakthrough Therapy Designation to GSK's Jemperli (dostarlimab) for locally advanced dMMR/MSI-H rectal cancer. • The designation was based on a Phase II trial showing a 100% clinical complete response rate in all 42 patients treated with dostarlimab. • Jemperli targets the PD-1 receptor and aims to improve the immune system's ability to eradicate cancer cells without traditional treatments. • The AZUR-1 trial is ongoing to confirm these findings, potentially changing the treatment paradigm for this subset of rectal cancer patients.

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Lenacapavir: Twice-Yearly Injection Shows High Efficacy in HIV Prevention

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FDA Accepts Gilead's Lenacapavir for HIV Prevention with Priority Review

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GSK Announces Q3 2024 Results: Specialty Medicines Drive Growth, Pipeline Strengthens

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Apretude Shows Over 99% Effectiveness in Real-World HIV Prevention Studies

• Real-world studies demonstrate Apretude (cabotegravir long-acting injectable) has over 99% effectiveness in preventing HIV, reinforcing its potential as a PrEP option. • The PILLAR implementation study reveals that Apretude reduces PrEP-related stigma and anxiety among men who have sex with men and transgender men, compared to daily oral PrEP. • Participants in the PILLAR trial reported high acceptability of Apretude, citing convenience and reduced worry about missing doses, despite some injection site reactions. • Flexible clinic scheduling, transportation assistance, and virtual appointments were identified as valuable facilitators of adherence to Apretude, enhancing its real-world impact.

ViiV Healthcare Triples HIV Prevention Drug Supply for Low-Income Nations

• ViiV Healthcare announces plans to provide 2 million doses of long-acting cabotegravir (Apretude) at not-for-profit pricing for low and middle-income countries through 2026. • The GSK-backed company has already initiated drug rollout in several nations including Zambia, Malawi, Zimbabwe, with plans to expand to nine additional countries by year-end. • This expansion of HIV prevention access aligns with ViiV's broader initiatives, including support for generic drug development through the Medicines Patent Pool agreement.

Gilead's Lenacapavir Shows Promise in HIV Prevention and Treatment

• Gilead's twice-yearly injectable lenacapavir reduced HIV infections by 96% in a Phase 3 trial, demonstrating superiority to daily oral Truvada for PrEP. • The PURPOSE 2 trial included cisgender men, transgender individuals, and gender non-binary people, showing broad efficacy across diverse populations. • Gilead plans to begin regulatory filings for lenacapavir for PrEP by the end of 2024, with potential launch in 2025, prioritizing access in high-incidence, resource-limited countries. • A Phase 2 trial of once-weekly oral islatravir and lenacapavir maintained viral suppression in adults with HIV, paving the way for Phase 3 trials.

Lenacapavir Shows High Efficacy in HIV Prevention, Faces Cost Accessibility Concerns

• Lenacapavir, a long-acting injectable HIV prevention drug, demonstrated 89% higher efficacy than daily oral medication in a key clinical trial. • Gilead Sciences' lenacapavir, dosed every six months, showed 100% efficacy in cisgender women, marking it as a potential game-changer. • Despite promising results, the high cost of lenacapavir raises concerns about equitable access and potential widening of racial disparities. • Gilead plans to seek FDA approval for lenacapavir as PrEP by year-end, with potential market availability by mid-to-late 2025.

Twice-Yearly Lenacapavir Injections Show 100% Efficacy in Preventing HIV in Women

• A clinical trial in South Africa and Uganda demonstrated that lenacapavir, administered via injection every six months, provided complete protection against HIV infection in young women. • The Purpose 1 trial compared lenacapavir to daily oral PrEP medications, Truvada (F/TDF) and Descovy (F/TAF), with lenacapavir showing significantly higher efficacy. • The trial's independent data safety monitoring board recommended halting the blinded phase due to the clear benefit of lenacapavir, offering all participants a choice of PrEP. • Gilead Sciences, the drug developer, plans to submit the trial results to regulatory bodies and the WHO, with hopes of incorporating lenacapavir into HIV prevention guidelines.
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