Update: FDA approved Descovy for PrEP on October 3, 2019.
You may have heard there’s now another medication on the market that can be used for HIV Pre-Exposure Prophylaxis (PrEP). This medication is called Descovy and is actually an updated formulation of the medication currently used for PrEP, Truvada. In early October 2019, the FDA approved Descovy for use for PrEP in cisgender men but not for use in women or transgender men.
Why the reason for the change?
Truvada is known to cause kidney dysfunction and decreased bone density in a very small percent of the population who takes it. This is why it’s important for patients on Truvada to have routine monitoring. In the study, Descovy caused much less kidney issues and had no negative effect on bone density.
The 94 week clinical trial that studied the efficacy of Descovy vs Truvada found that Descovy is non-inferior to Truvada. In medical terms, Descovy was not worse than Truvada for PrEP. In other words, Descovy works just as well as Truvada.
Switching from Truvada to Descovy should be a no-brainer right?
This switch should be made in patients who have experienced renal or bone issues on Truvada, but what about others who have done just fine on Truvada?
Well, that’s where the discussion gets a little more complicated. The patent for Truvada will end in 2020, meaning the generic version of the drug may come available soon thereafter. Switching patients from Truvada to Descovy will likely result in higher costs as Gilead (the maker of the drug) will have a patent on Descovy for the foreseeable future.
At this point, if you are on Truvada, you will likely stay on Truvada for the foreseeable future. If you are someone who had to discontinue Truvada due to kidney or bone issues, Descovy may be a good option for you, though it will still be important to monitor your kidney function while taking this medication.
Despite Descovy for PrEP being approved by the FDA, it may up to six months or more for insurances to start covering this drug in their formulary. In the meantime, patients should continue on Truvada, and in those patients where Descovy may be a better option, you will be switched once the medication becomes covered by your insurance plan.
Is there still a place for Truvada?
The truth is that Truvada has been and will continue to be a very effective tool for combatting new HIV infections. One of the main barriers for patients going on PrEP has been access to care and, for many patients, cost. While many insured patients are able to obtain the drug for zero dollars out-of-pocket in many cases, uninsured patients often find the cost of the drug leaves it out-of-reach. Despite the Ryan White program and programs like Gilead’s Advancing Access, there are still many at-risk individuals who are not on Truvada.
When Truvada goes generic and the cost of the drug dramatically decreases, the hope is that this will help bridge the gap for patients who have been left behind. Moreover, Descovy will also give medical providers more options to prescribe PrEP for those with renal issues or those who had kidney or bone density issues while taking Truvada.
If you feel you are at-risk for HIV, speak with your medical provider to discuss PrEP and other ways to lower your risk of HIV or STI infection. If you are HIV positive, make an appointment with one of our HIV specialists to ensure you’re on the most appropriate medication regimen.
Jeremiah Robinson is a licensed and certified Physician Assistant at T. Douglas Gurley MD in Atlanta, GA.