Treatment Guideline Recommendations | HCP Site

DHHS Guidelines Highlight Importance of Achieving Suppression When Choosing New ARV Agents¹

ARV regimen considerations for treatment-experienced patients

suppression is essential

The primary goal of treatment for ART-experienced patients with drug resistance experiencing virologic failure is to establish suppression.

Potency is critical

For patients with virologic failure, consider expected potency of additional agent(s), taking into account the patient's ART history, resistance, and availability of a new MOA.

INCLUDES 2-3 FULLY ACTIVE AGENTS

For multiple or extensive drug resistance with few treatment options, a new regimen should include at least 2, and preferably 3, fully active agents (including those with novel mechanisms of action). If choosing a regimen with fewer than 3 fully active drugs, include as many fully active drugs as possible, along with potentially partially active drugs.

Beware of cross-resistance

The use of a new drug does not ensure that it will be fully active due to the potential for cross-resistance among drugs from the same class.

LEARN ABOUT THE MOA OF SUNLENCA®

INDICATION

SUNLENCA, in combination with other antiretroviral(s), is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in heavily treatment-experienced adults with multidrug resistant HIV-1 whose current antiretroviral regimen is failing due to resistance, intolerance, or safety considerations.

Important Safety Information

Contraindications

Coadministration: Concomitant administration of SUNLENCA is contraindicated with strong CYP3A inducers.

Warnings and precautions

Immune reconstitution syndrome, including the occurrence of autoimmune disorders with variable time to onset, has been reported in patients treated with combination antiretroviral (ARV) therapy.

INDICATION

SUNLENCA, in combination with other antiretroviral(s), is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in heavily treatment-experienced adults with multidrug resistant HIV-1 whose current antiretroviral regimen is failing due to resistance, intolerance, or safety considerations.

Tap for Important Safety Information

Important Safety Information

Contraindications

Coadministration: Concomitant administration of SUNLENCA is contraindicated with strong CYP3A inducers.

Warnings and precautions

Immune reconstitution syndrome, including the occurrence of autoimmune disorders with variable time to onset, has been reported in patients treated with combination antiretroviral (ARV) therapy.

INDICATION

SUNLENCA, in combination with other antiretroviral(s), is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in heavily treatment-experienced adults with multidrug resistant HIV-1 whose current antiretroviral regimen is failing due to resistance, intolerance, or safety considerations.

Long-acting properties and potential associated risks with SUNLENCA: Residual concentrations of SUNLENCA may remain in the systemic circulation of patients for up to 12 months or longer. SUNLENCA may increase exposure, and potential risk of adverse reactions, to drugs primarily metabolized by CYP3A initiated within 9 months after last injection. Counsel patients regarding the dosing schedule because nonadherence could lead to loss of virologic response and development of resistance. If virologic failure occurs, switch to an alternative regimen if possible. If discontinuing SUNLENCA, begin alternate suppressive ARV regimen within 28 weeks from last injection.
Injection site reactions may occur, and nodules and indurations may be persistent. Improper administration (intradermal injection) has been associated with serious injection site reactions.

Adverse reactions

Most common adverse reactions (incidence ≥3%, all grades) are injection site reactions (65%) and nausea (4%).

Drug interactions

Prescribing information: Consult the full prescribing information for SUNLENCA for more information on Contraindications, Warnings, and potentially significant drug interactions, including clinical comments.
Enzymes/transporters: Drugs that are strong or moderate inducers of CYP3A may significantly decrease the concentration of SUNLENCA. Drugs that strongly inhibit CYP3A, P-gp, and UGT1A1 together may significantly increase the concentration of SUNLENCA. SUNLENCA may increase the exposure of drugs primarily metabolized by CYP3A, when initiated within 9 months after the last injection of SUNLENCA, which may increase the potential risk of adverse reactions.

Dosage and administration

Dosage: Initiation with 1 of 2 options, followed by maintenance injection dosing once every 6 months. Tablets may be taken with or without food.
- Initiation Option 1: Day 1: 927 mg by subcutaneous injection and 600 mg orally (2 x 300-mg tablets). Day 2: 600 mg orally (2 x 300-mg tablets).
- Initiation Option 2: Day 1: 600 mg orally (2 x 300-mg tablets). Day 2: 600 mg orally (2 x 300-mg tablets). Day 8: 300 mg orally (1 x 300-mg tablet). Day 15: 927 mg by subcutaneous injection.
- Maintenance: 927 mg by subcutaneous injection every 26 weeks +/- 2 weeks from date of last injection.
Planned missed injections: If scheduled injection is to be missed by more than 2 weeks, SUNLENCA tablets may be used for oral bridging for up to 6 months until injections resume. Dosage is 300 mg orally (1 x 300-mg tablet) every 7 days.
Unplanned missed injections: During the maintenance period, if more than 28 weeks have elapsed since the last injection and tablets have not been taken for oral bridging, restart the initiation dosage regimen from Day 1, using Option 1 or Option 2, if clinically appropriate.

Pregnancy and lactation

Pregnancy: There is insufficient human data on the use of SUNLENCA during pregnancy. An Antiretroviral Pregnancy Registry (APR) has been established.
Lactation: Individuals with HIV-1 infection should be informed of the potential risks of breastfeeding.

Please see full Prescribing Information for SUNLENCA.