Apretude vs Descovy: How do they compare?

Key Points

• Apretude (cabotegravir) and Descovy (emtricitabine and tenofovir alafenamide) are two prescription antiviral medications used for pre-exposure prophylaxis (PrEP) to reduce the risk of getting HIV. Descovy is also used to treat HIV-1 infection.
• Apretude is an intramuscular injection given by a healthcare provider every 2 months after the first two injections.
• Descovy is an oral tablet that is taken once a day.
• Injection site reactions are common from taking Apretude. The most common side effects from Descovy are diarrhea and nausea.

Apretude (cabotegravir) and Descovy (emtricitabine and tenofovir alafenamide) are both effective options for HIV pre-exposure prophylaxis (PrEP), but they differ in how they are taken, dosing frequency, and side effects. In addition to PrEP, Descovy may also be taken to treat HIV-1 infection. Apretude is not approved to treat HIV, and should only be taken to prevent a sexually-aquired HIV infection.

What is Apretude?

Apretude (cabotegravir) is a long-acting injection that contains an antiviral medication. It was FDA approved in December 2021 for pre-exposure prophylaxis (PrEP) to lower the risk of HIV infection from sex in people 12 years and older weighing at least 35 kg (77 lbs). It is the first injectable medication approved for HIV PrEP.

Apretude is given as two injections by a healthcare provider one month apart, and then every two months. This option may be attractive for those who do not want to take a daily pill. Patients must have a negative HIV-1 test before starting Apretude.

In clinical studies that included over 7,700 people, Apretude was superior to Truvada in preventing HIV infection.

What is Descovy?

Descovy (emtricitabine and tenofovir alafenamide) is a combination medication that contains two antiviral medications. It comes as an oral tablet that may be used for:

• HIV PrEP to lower the risk of HIV infection from sex in people weighing at least 35 kg (77 lbs), excluding people at risk from receptive vaginal sex
• Treatment of HIV-1 infection in people weighing at least 35 kg (in combination with other antiviral medications)
• Treatment of HIV-1 infection in people weighing between 14 kg (31 lbs) and 35 kg (in combination with other antiviral medications other than protease inhibitors that require a CYP3A inhibitor)

Descovy was first approved in April 2016 for the treatment of HIV-1 infection, and again in October 2019 for HIV PrEP. Before taking it for PrEP, patients must have a negative HIV-1 test.

How does Apretude work?

Apretude contains cabotegravir, which is an integrase strand transfer inhibitor (INSTI). It works by blocking an HIV protein called integrase. This prevents viral DNA from integrating into human T-cell genetic material, which stops the virus from multiplying. Having Apretude in your system during an exposure to the HIV virus reduces your risk of getting infected.

How does Descovy work?

Descovy contains two antiviral medications, emtricitabine (also known as FTC) and tenofovir alafenamide (TAF). Both medications are HIV nucleoside analog reverse transcriptase inhibitors (NRTIs). They work by blocking an HIV protein called reverse transcriptase that makes RNA into DNA. Stopping this action prevents the virus from multiplying and spreading in the body.

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What is the dosing for Apretude and Descovy?

Apretude is available as a long-acting injection, while Descovy is an oral tablet. The dosing of these medications is not the same.

Descovy comes as an oral tablet and is available in two different strengths:

• 200 mg emtricitabine and 25 mg of tenofovir alafenamide
• 120 mg emtricitabine and 15 mg tenofovir alafenamide

Dosing of Descovy depends on the reason you are taking it and your body weight:

• For HIV PrEP and the treatment of HIV in patients weighing at least 35 kg, the recommended dosage is 1 tablet (200 mg FTC / 25 mg TAF) by mouth once a day with or without food.
• For HIV treatment in patients weighing 25 kg to less than 35 kg, the recommended dosage is 1 tablet (200 mg FTC / 25 mg TAF) by mouth once a day with or without food.
• For HIV treatment in patients weighing 14 kg to less than 25 kg, the recommended dosage is 1 tablet (120 mg FTC / 15 mg TAF) by mouth once a day with or without food.

Apretude comes as an extended-release, or long-acting, intramuscular injection. It must be injected by a healthcare provider into the gluteal (buttocks) muscle. Your healthcare provider might start you on oral cabotegravir to see how you tolerate the medication before switching you to the injectable form. When switching to injectable Apretude, the injection should be given on the last day of the oral medication or within 3 days after stopping.

The recommended starting dosage of Apretude is 600 mg injected one month apart for two months in a row. Then, the recommended dose is 600 mg injected once every two months.

What are the side effects of Apretude and Descovy?

Like most medications, Apretude and Descovy have potential side effects. They share some similar side effects, but others are different.

The most common side effect of Apretude is injection site reactions, such as redness, pain, and swelling at the injection site. In clinical trials, up to 82% of patients reported injection site reactions. Other common side effects you may experience with Apretude include diarrhea, headache, fever, fatigue, sleep problems, and nausea.

Because Descovy is taken in combination with other antiviral medications, it can be hard to know which side effects are due to Descovy specifically. In studies of patients taking it with elvitegravir and cobicistat, the most common side effect reported was nausea (10%).

During studies for HIV PrEP, side effects of Descovy were compared to Truvada. The most common side effects of Descovy reported were:

• Diarrhea (5% vs. 6% in patients taking Truvada)
• Nausea (4% vs. 5% in patients taking Truvada)
• Headache (2% vs. 2% in patients taking Truvada)
• Fatigue (2% vs. 3% in patients taking Truvada)
• Stomach pain (2% vs. 3% in patients taking Truvada)

This is not all the information you need to know about Apretude (cabotegravir injection) or Descovy (emtricitabine and tenofovir alafenamide) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.