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Lenacapavir

Phase 3

Pre-Exposure Prophylaxis of HIV Infection | Small molecule | Infectious Disease |Gilead Sciences, Inc.|Last Updated: May 19, 2026

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials5
Total Enrollment9,362
FDA Designations
No designations recorded
Clinical Trials (5)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT04994509Pre-Exposure Prophylaxis Study of Lenacapavir and Emtricitabine/Tenofovir Alafenamide in Adolescent Girls and Young Women at Risk of HIV InfectionPHASE3 ACTIVE NOT_RECRUITING 5,368Aug 30, 2021Jan 1, 2028Mar 30, 202628 South Africa, Uganda
NCT04925752Study of Lenacapavir for HIV Pre-Exposure Prophylaxis in People Who Are at Risk for HIV InfectionPHASE3 ACTIVE NOT_RECRUITING 3,292Jun 28, 2021Aug 1, 2028Dec 23, 202593 United States, Argentina +6
NCT06513312Study of Lenacapavir Taken Twice a Year for HIV Pre-Exposure Prophylaxis (PrEP)PHASE2 ACTIVE NOT_RECRUITING 268Oct 7, 2024Nov 1, 2028May 19, 202614 France, United Kingdom
NCT06101342Study of Lenacapavir and Emtricitabine/Tenofovir Disoproxil Fumarate (F/TDF) for Prevention of HIV in People Who Inject Drugs (HPTN 103)PHASE2 ACTIVE NOT_RECRUITING 181Dec 13, 2023Jan 1, 2028Mar 2, 20269 United States
NCT06101329Study of Lenacapavir and Emtricitabine/Tenofovir Disoproxil Fumarate (F/TDF) in Prevention of HIV in Cisgender Women in the United States (HPTN 102)PHASE2 ACTIVE NOT_RECRUITING 253Nov 17, 2023Jan 1, 2028Sep 23, 202511 United States
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Study Endpoints
Primary Endpoints
Incidence Phase: Recent Infection Testing Algorithm (RITA) Estimate of the Background Human Immunodeficiency-1 Virus Infection Incidence Rate (bHIV) Per 100 Person Years (PY)
Incidence Phase Screening Visit (Day 1)

bHIV per 100 PY in the Incidence Phase was calculated using RITA. The RITA incorporated HIV-1 testing results and recency assay testing results to estimate the bHIV. Recency assay testing was performed for participants in the All Screened Set found to have HIV-1 infection at the Incidence Phase Screening Visit as defined below. Participants were considered to have recent HIV-1 infection if the normalized optical density (ODn) was below 1.5 threshold using the Sedia limiting antigen avidity enzyme immunoassay (LAg-EIA) and the HIV-1 RNA (viral load) was \> 75 copies/mL of blood. HIV-1 infection was defined as participants having at least one of the following central lab results at the Incidence Phase screening visit: * Positive HIV-1/2 differentiation Ab, OR * Positive HIV-1 ribonucleic acid (RNA) qualitative test, OR * HIV-1 RNA quantitative test ≥200 copies/mL.

Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN and F/TAF Compared to Participants in All Screened Set
When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)

HIV-1 incidence per 100 PY for LEN and F/TAF was calculated as the number of participants who acquired HIV-1 divided by the total of a) for participants not diagnosed with HIV-1, sum of all duration of follow-up time in years, while at risk of HIV-1 infection (where a year is 365.25 days) and b) for participants diagnosed with HIV-1, sum of all duration of follow-up time up to confirmed HIV-1 diagnoses. HIV-1 diagnosis was determined by an HIV adjudication committee who reviewed potential HIV-1 infection events in the randomized participants. The committee, in a blinded, consistent, and unbiased manner, determined whether HIV test results confirmed HIV-1 infection and determined the date of diagnosis for each case, defined as the date of the earliest study visit with evidence of HIV infection considering both prospective HIV testing and back-testing of archived samples. bHIV incidence per 100 PY in All Screened Set was estimated as described in outcome measure#1.

Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN Compared to Background HIV (bHIV, Participants in All Screened Set)
Up to 149 weeks

HIV-1 incidence per 100 PY for LEN was calculated as the number of participants who acquired HIV-1 divided by the total of a) for participants not diagnosed with HIV-1, sum of all duration of follow-up time in years, while at risk of HIV-1 infection (where a year is 365.25 days) and b) for participants diagnosed with HIV-1, sum of all duration of follow-up time up to confirmed HIV-1 diagnoses. HIV-1 diagnosis was determined by an HIV adjudication committee who reviewed potential HIV-1 infection events in the randomized participants. The committee, in a blinded, consistent, and unbiased manner, determined whether HIV test results confirmed HIV-1 infection and determined the date of diagnosis for each case, defined as the date of the earliest study visit with evidence of HIV infection considering both prospective HIV testing and back-testing of archived samples. bHIV incidence per 100 PY in All Screened Set was estimated as described in outcome measure#1.

Percentage of Participants with LEN and F/TDF Persistence through 52 Weeks
Up to Week 52

This outcome measure will compare LEN and F/TDF persistence through 52 weeks, where persistence is defined by On-time LEN Injection at Day 1/Baseline and Week 26 and On-time Follow-up Visit at Week 52 for LEN arm and by Adherence Levels Based on tenofovir diphosphate (TFV-DP) concentrations in red blood cells consistent with ≥ 4 doses/week (≥ 700 fmol/punch) in dried blood spot (DBS) at Weeks 13, 26, 39, and 52 for F/TDF arm.

Pharmacokinetic (PK) Parameter: Ctrough for Lenacapavir (LEN): LEN Plasma concentration at the End of the Dosing Interval (Week 26)
Week 26
PK Parameter: Ctrough for LEN: LEN Plasma concentration at the End of the Dosing Interval (Week 52)
Week 52
Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs)
First dose date up to 30 days post last dose at Week 78
Percentage of Participants Experiencing Treatment-emergent Clinical Laboratory Abnormalities with LEN and F/TDF
First dose date up to 30 days post last dose at Week 78
Pharmacokinetic (PK) Parameter: Ctrough for Lenacapavir (LEN) at the End of Week 26
Week 26

Ctrough is defined as the concentration at the end of the dosing interval.

PK Parameter: Ctrough for LEN at the End of Week 52
Week 52

Ctrough is defined as the concentration at the end of the dosing interval.

Percentage of Participants Experiencing Treatment-emergent Clinical Laboratory Abnormalities
First dose date up to 30 days post last dose at Week 78
General Acceptability of LEN and F/TDF as PrEP as Assessed by Percentage of Participants with Acceptability Questionnaire Responses
Up to Week 52

To assess the acceptability of the study drug, participants will complete the questionnaire including a question on general acceptability of the assigned study drug on an ordinal 5-category scale with a response of: Completely unacceptable, Unacceptable, No opinion, Acceptable, or Completely acceptable.

Satisfaction With Use of LEN and F/TDF as PrEP as Assessed by Percentage of Participants with Satisfaction Questionnaire Responses
Up to Week 52

To assess the satisfaction with use of the study drug, participants will complete the questionnaire including a question on satisfaction with use of the assigned study drug on an ordinal 5-category scale with a response of: Very satisfied, Satisfied, Neutral, Dissatisfied, or Very dissatisfied.

Willingness to Use LEN and F/TDF as PrEP as Assessed by Percentage of Participants with Willingness to Use Questionnaire Responses
Up to Week 52

To assess the willingness to use the study drug, participants will complete the questionnaire including a question on willingness to use the assigned study drug on an ordinal 5-category scale with a response of: Definitely Yes, Probably yes, Not sure/undecided, Probably No, or Definitely No.

Secondary Endpoints
Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN, F/TAF and F/TDF
When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)
Randomized Blinded Phase: HIV-1 Incidence Among Participants Adherent to LEN
When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)
Randomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched Controls
When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)
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Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposePREVENTION
Treatment Arms
ArmTypeDescription
Randomized Blinded Phase: LenacapavirEXPERIMENTALParticipants will receive lenacapavir (LEN) 927 mg injection, every 26 weeks starting on Day 1 for up to approximately 52 weeks. Participants will also receive loading dose of LEN 600 mg, tablet, once daily on Day 1 and Day 2. Participants will receive placebo to match (PTM) emtricitabine/tenofovir disoproxil fumarate (F/TDF) or PTM emtricitabine/tenofovir alafenamide (F/TAF), once daily, up to approximately 52 weeks.
Randomized Blinded Phase: F/TAFEXPERIMENTALParticipants will receive F/TAF, once daily up to approximately 52 weeks. Participants will also receive PTM LEN injection, every 26 weeks, starting on Day 1 up to approximately 52 weeks. Participants will receive PTM LEN tablet, once daily on Day 1 and Day 2.
Randomized Blinded Phase: F/TDFEXPERIMENTALParticipants will receive F/TDF, once daily up to approximately 52 weeks. Participants will also receive PTM LEN injection, every 26 weeks starting on Day 1 up to approximately 52 weeks. Participants will receive PTM LEN tablet, once daily on Day 1 and Day 2.
LEN Open-Label Extension (OLE) PhaseEXPERIMENTALAfter completion of the Blinded phase, participants will be offered entry into the LEN OLE Phase. Participants randomized to LEN will continue to receive LEN 927 mg injection, every 26 weeks until LEN becomes available or the sponsor elects to discontinue the study, whichever occurs first. Participants randomized to F/TAF or F/TDF will receive LEN 927 mg injection on OLE Day 1, Week 26, and every 26 weeks thereafter. Participants will also receive LEN 600 mg tablet on OLE Days 1 and 2.
Pharmacokinetic (PK) Tail Coverage PhaseEXPERIMENTALParticipants who prematurely discontinue study drug in the randomized blinded phase will transition into the PK Tail Coverage phase. Participants will receive F/TDF, once daily, for 78 weeks beginning 26 weeks after the last LEN injection.
Randomized Blinded Phase: LEN + Placebo-to-match (PTM) F/TDFEXPERIMENTALParticipants will receive the following for up to approximately 52 weeks: * Subcutaneous (SC) lenacapavir (LEN) 927 mg every 26 weeks * Oral PTM Emtricitabine/Tenofovir Disoproxil Fumarate (F/TDF) once daily * Oral LEN 600 mg on Days 1 and 2 Participants will receive oral LEN if SC injections are not available.
Randomized Blinded Phase: Placebo LEN + F/TDFEXPERIMENTALParticipants will receive the following for up to approximately 52 weeks: * SC LEN placebo every 26 weeks * Oral F/TDF 200/300 mg once daily * PTM Oral LEN on Days 1 and 2 Participants will receive oral LEN placebo if SC injections are not available.
Pharmacokinetic (PK) Tail PhaseEXPERIMENTALParticipants who prematurely discontinue study drug during the Randomized Blinded Phase and participants that were randomized to LEN who choose not to continue in the LEN OLE Phase will transition to the PK Tail Phase. Participants will receive oral F/TDF (or Emtricitabine/Tenofovir Alafenamide (F/TAF) for US participants only) once daily for 78 weeks to cover the PK tail and complete visits every 13 weeks (+/- 7 days). Upon unblinding, participants who were randomized to F/TDF in the Randomized Blinded Phase who decline to participate in the LEN OLE Phase will complete the ESDD visit, transition to local HIV prevention services, and return for a 30-day follow-up visit.
Randomized Phase: Lenacapavir (LEN) GroupEXPERIMENTALParticipants will receive subcutaneous (SC) LEN 927 mg on Day 1 and 26 weeks and oral LEN 600 mg on Day 1 and 2.
Randomized Phase: F/TDFACTIVE_COMPARATORParticipants will receive daily F/TDF (200/300 mg) fixed dose combination (FDC) tablets for up to 52 weeks.
LEN Open Label Extension (OLE) PhaseEXPERIMENTALParticipants in the F/TDF group will transition to get LEN and participants in the LEN group will continue to get LEN. All participants will get SC LEN on Day 1 and week 26 of the OLE phase.
Pharmacokinetic (PK) Tail Phase: F/TDFEXPERIMENTALAfter completion of the LEN OLE Phase or upon discontinuation from the Randomized Phase for those receiving LEN, participants will be transitioned to receive F/TDF in the PK Tail Phase. Participants will receive once daily F/TDF for 78 weeks, beginning 26 weeks after the last LEN injection
Randomized Phase: Emtricitabine/ Tenofovir Disoproxil Fumarate (F/TDF) GroupEXPERIMENTALParticipants will receive daily F/TDF (200/300 mg) fixed dose combination (FDC) tablets for up to 52 weeks.
Open-label Extension Phase: LENEXPERIMENTALParticipants randomized to LEN in the Randomized Phase who choose to participate in the LEN Open-Label Extension (OLE) Phase will receive SC LEN every 26 weeks (± 7 days) and have study visits every 13 weeks (± 7 days). Participants randomized to F/TDF in the Randomized Phase who choose to participate in LEN OLE Phase will switch to SC LEN and have study visits at LEN OLE Day 1, Week 4 (± 2 days), Week 13 (± 7 days), and every 13 weeks (± 7 days) thereafter. SC LEN will be administered at the LEN OLE Day 1 visit and every 26 weeks thereafter. These participants will also receive loading doses of oral LEN on OLE Days 1 and 2. Upon completion of the LEN OLE Phase, participants will transition to local HIV prevention services and return for a 30-day follow-up visit. At that time, participation in the study will end.
Randomized Phase: Emtricitabine/Tenofovir Disoproxil Fumarate (F/TDF) GroupEXPERIMENTALParticipants will receive oral F/TDF (200/300 mg) daily for 52 weeks.
PK Tail Phase: F/TDFEXPERIMENTALAfter the completion of the Randomized Phase, participants in LEN group will be transitioned to receive F/TDF and participants in F/TDF group will continue to receive F/TDF in the PK Tail Phase. All participants will receive F/TDF, once daily for 78 weeks beginning 26 weeks after the last LEN injection.
Interventions
NameTypeDescription
Oral Lenacapavir (LEN)DRUGTablets administered orally without regard to food
Subcutaneous (SC) Lenacapavir (LEN)DRUGAdministered via SC injections
F/TAFDRUGTablets administered orally
F/TDFDRUGTablets administered orally
Placebo SC LENDRUGAdministered via SC injections
PTM Oral LENDRUGTablets administered orally
PTM F/TAFDRUGTablets administered orally
PTM F/TDFDRUGTablets administered orally
Sub-cutaneous (SC) Lenacapavir (LEN)DRUGAdministered via SC injections
F/TAF (for US participants only)DRUGF/TAF tablets administered orally once daily
Lenacapavir InjectionDRUGAdministered subcutaneously
Lenacapavir TabletDRUGAdministered orally
Emtricitabine/tenofovir disoproxil fumarate (F/TDF)DRUGAdministered orally
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Eligibility Criteria
Age Range16 Years — 25 Years
SexFEMALE
Healthy VolunteersYes
Study Sites28

Key Inclusion Criteria: * Incidence Phase * HIV-1 status unknown at initial screening and no prior human immunodeficiency virus (HIV)-1 testing within the last 3 months. * Sexually active (has had \> 1 vaginal intercourse within the last 3 months) with cisgender male individuals (CGM). * Rando...

Countries:South AfricaUgandaUnited StatesArgentinaBrazilMexicoPeruPuerto RicoThailandFranceUnited Kingdom
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Recent Changes (Last 90 Days)
LOWMay 26, 2026NCT04994509primaryCompletionDate: changed
LOWMay 26, 2026NCT04925752primaryCompletionDate: changed
LOWMay 26, 2026NCT06513312primaryCompletionDate: changed
LOWMay 26, 2026NCT06101329primaryCompletionDate: changed
LOWMay 26, 2026NCT06101342primaryCompletionDate: changed
LOWMay 24, 2026NCT04994509studyFirstPostDate: changed
LOWMay 24, 2026NCT04925752studyFirstPostDate: changed
LOWMay 24, 2026NCT06513312studyFirstPostDate: changed
LOWMay 24, 2026NCT06101329studyFirstPostDate: changed
LOWMay 24, 2026NCT06101342studyFirstPostDate: changed