Lenacapavir Sodium

1 INDICATIONS AND USAGE YEZTUGO is indicated for pre‑exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in adults and adolescents weighing at least 35 kg who are at risk for HIV-1 acquisition. Individuals must have a negative HIV-1 test prior to initiating YEZTUGO [see Dosage and Administration (2.1) and Warnings and Precautions (5.1) ]. YEZTUGO, a human immunodeficiency virus type 1 (HIV-1) capsid inhibitor, is indicated for pre‑exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in adults and adolescents weighing at least 35 kg who are at risk for HIV-1 acquisition. Individuals must have a negative HIV-1 test prior to initiating YEZTUGO. ( 1 )

2 DOSAGE AND ADMINISTRATION HIV-1 screening: Screen all individuals for HIV-1 infection prior to initiating YEZTUGO, prior to each injection of YEZTUGO, and additionally as clinically appropriate. ( 2.1 ) Dosing schedule: Initiation dosing (injection and tablets) followed by once every 6-months continuation injection dosing. Tablets may be taken without regard to food. ( 2.3 ) Initiation Day 1 927 mg by subcutaneous injection (2 x 1.5 mL injections) and 600 mg orally (2 x 300 mg tablets) Day 2 600 mg orally (2 x 300 mg tablets) Continuation 927 mg by subcutaneous injection (2 x 1.5 mL injections) every 6-months (26 weeks) from the date of the last injection +/-2 weeks. Anticipated delayed injections: If scheduled injection is anticipated to be delayed by more than 2 weeks, YEZTUGO tablets may be used on an interim basis (for up to 6 months if needed) until injections resume. Dosing schedule for delayed injection is 300 mg orally once every 7 days. ( 2.4 ) Missed injections: If more than 28 weeks have elapsed since the last injection and tablets have not been taken, restart initiation from Day 1 if clinically appropriate. ( 2.4 ) Dosage modifications (supplemental doses) of YEZTUGO are recommended when initiating strong or moderate CYP3A inducers. ( 2.5 ) YEZTUGO injection is for subcutaneous administration only. Two 1.5 mL injections are required for complete dose. ( 2.6 ) 2.1 HIV-1 Screening for Individuals Receiving YEZTUGO for HIV-1 Pre-Exposure Prophylaxis Screen all individuals for HIV-1 infection prior to initiating YEZTUGO, prior to each subsequent injection of YEZTUGO, and additionally as clinically appropriate, using a test approved or cleared by the FDA for the diagnosis of acute or primary HIV-1 infection. When screening for HIV-1 infection prior to initiating YEZTUGO, if an antigen/antibody-specific test is used and provides negative results, then such negative results should be confirmed using an RNA-specific assay, even if the results of the RNA-assay are available after YEZTUGO initiation. When screening for HIV-1 infection prior to continuing YEZTUGO, negative results from a rapid, point-of-care antigen/antibody test should be confirmed using a more sensitive assay [see Indications and Usage (1) , Contraindications (4) , Warnings and Precautions (5.1 , 5.2) and Clinical Studies (14) ]. 2.2 Adherence to YEZTUGO Prior to starting YEZTUGO, healthcare providers should select individuals who agree to the required testing and every 6 month injection dosing schedule, and counsel individuals about the importance of adherence to scheduled YEZTUGO dosing visits to help reduce the risk of acquiring HIV-1 infection and development of resistance [see Dosage and Administration (2.1) , Warnings and Precautions (5.1 , 5.2) , and Microbiology (12.4) ] . 2.3 Recommended Dosage The YEZTUGO dosing schedule in adults and adolescents weighing at least 35 kg consists of a required initiation dosing (subcutaneous injections and oral tablets) followed by once every 6-months continuation dosing (subcutaneous injections) ( Table 1 ). YEZTUGO oral tablets may be taken with or without food [see Clinical Pharmacology (12.3) ] . Table 1. Dosing Schedule for YEZTUGO Initiation and Continuation in Adults and Adolescents Weighing at Least 35 kg Time Dosage of YEZTUGO: Initiation The complete initiation dosing schedule, consisting of subcutaneous injections and oral tablets, is required; the efficacy of YEZTUGO has only been established with this dosing schedule. Day 1 927 mg by subcutaneous injection (2 x 1.5 mL injections) and 600 mg orally (2 x 300 mg tablets) Day 2 600 mg orally (2 x 300 mg tablets) Dosage of YEZTUGO: Continuation Every 6-months (26 weeks) From the date of the last injection. +/-2 weeks 927 mg by subcutaneous injection (2 x 1.5 mL injections) 2.4 Dosing Schedule for Missed Dose Missed Oral Initiation Dose If the Day 2 oral initiation dose (600 mg; see Table 1 ) is missed, take it as soon as possible. Do not take Day 1 and Day 2 oral initiation doses on the same day. Anticipated Delayed Injections During continuation dosing, if the scheduled 6-month injection is anticipated to be delayed by more than 2 weeks, YEZTUGO tablets may be taken on an interim basis (for up to 6 months if needed), until injections resume. Refer to Table 2 below for the dosing schedule for delayed injections. Table 2. Dosing Schedule for Anticipated Delayed Injections: Weekly Oral Dosage Time since Last Injection Dosage of YEZTUGO 26 to 28 weeks Oral dosage of 300 mg taken once every 7 days. Use on an interim basis only (for up to 6 months if needed). Resume the continuation injection dosage within 7 days after the last oral dose. Missed Injections Individuals who miss a scheduled injection visit should be clinically reassessed to ensure resumption of YEZTUGO remains appropriate and that the individual remains HIV-1 negative. During continuation dosing, if more than 28 weeks have elapsed since the last injection and YEZTUGO tablets have not been taken, see Table 3 below for the dosing schedule after missed injections. Adherence to the injection dosing schedule is strongly recommended [see Dosage and Administration (2.2) and Microbiology (12.4) ]. Table 3. Dosing Schedule after Missed Injections Time since Last Injection Dosage of YEZTUGO More than 28 weeks Reinitiate with initiation dosing schedule from Day 1 ( Table 1 ) and then continue with continuation injection dosing. 2.5 Dosage Modifications for Co-administration with Strong or Moderate CYP3A Inducers Supplemental doses of YEZTUGO are recommended for individuals initiating therapy with either strong CYP3A inducers (see Table 4 ) or moderate CYP3A inducers (see Table 5 ) [see Drug Interactions (7.1) and Clinical Pharmacology (12.3) ] . Strong CYP3A inducers may be initiated starting at least 2 days after YEZTUGO is first initiated, while moderate CYP3A inducers may be started any time after YEZTUGO is first initiated. Table 4. Dosing Recommendations for Individuals Receiving YEZTUGO and Initiating Therapy with Strong CYP3A Inducers Dosing recommendations are not available for the initiation of YEZTUGO in individuals already receiving strong CYP3A inducers, nor in individuals receiving the weekly oral dosage of YEZTUGO (see Table 2 ) . Maintain Scheduled Continuation Injection Dosing Schedule for Supplemental Doses of YEZTUGO Time Dosage Continue to administer once every 6-months scheduled continuation dosing of YEZTUGO 927 mg subcutaneously (2 x 1.5 mL injections) (see Table 1 ), plus administer supplemental doses of YEZTUGO as shown in this table On day strong CYP3A inducer is initiated (which should be at least 2 days after YEZTUGO is first initiated) Supplemental dosage: Step 1 927 mg subcutaneously (2 x 1.5 mL injections) and 600 mg orally (2 x 300 mg tablets) On day after strong CYP3A inducer is initiated Supplemental dosage: Step 2 600 mg orally (2 x 300 mg tablets) If strong CYP3A inducer is co-administered for longer than 6 months Subsequent supplemental dosage Every 6-months 26 weeks +/-2 weeks. from initiation of strong CYP3A inducer, continue to administer supplemental doses of YEZTUGO as described above in Steps 1 and 2. After stopping the strong CYP3A inducer, continue the once every 6-months scheduled continuation injection dosing of YEZTUGO (see Table 1 ) . Table 5. Dosing Recommendations for Individuals Receiving YEZTUGO and Initiating Therapy with Moderate CYP3A Inducers Dosing recommendations are not available for the initiation of YEZTUGO in individuals already receiving moderate CYP3A inducers, nor in individuals receiving the weekly oral dosage of YEZTUGO (see Table 2 ) . Maintain Scheduled Continuation Injection Dosing Schedule for Supplemental Doses of YEZTUGO Time Dosage Continue to administer once every 6-months scheduled continuation dosing of YEZTUGO 927 mg subcutaneously (2 x 1.5 mL injections) (see Table 1 ), plus administer supplemental doses of YEZTUGO as shown in this table On day moderate CYP3A inducer is initiated Supplemental dosage 463.5 mg subcutaneously (1 x 1.5 mL injection) If moderate CYP3A inducer is co-administered for longer than 6 months Subsequent supplemental dosage Every 6-months 26 weeks +/-2 weeks. from initiation of moderate CYP3A inducer, continue to administer a supplemental dose of YEZTUGO as described above. After stopping the moderate CYP3A inducer, continue the once every 6-months scheduled continuation injection dosing of YEZTUGO (see Table 1 ) . 2.6 Preparation and Administration of Subcutaneous Injection YEZTUGO injection is only for subcutaneous administration into the abdomen by a healthcare provider. The thigh can be used as an alternative injection site if preferred. Do NOT administer intradermally due to risk of serious injection site reactions [see Warnings and Precautions (5.4) ]. Use aseptic technique. Visually inspect the solution in the vials and prepared syringe for particulate matter and discoloration prior to administration. YEZTUGO injection is a yellow solution. Do not use YEZTUGO injection if the solution is discolored or if it contains particulate matter. Once the solution is withdrawn from the vials, the subcutaneous injections should be administered as soon as possible [see How Supplied/Storage and Handling (16) ]. Figure 1 identifies the components for use in the administration steps for the withdrawal needle injection kit, and the administration steps are provided in Figure 2 . The 18-gauge needle is for withdrawal only in this kit. The injection kit components are for single use only. Two 1.5 mL injections are required for a complete dose. Figure 1 YEZTUGO Withdrawal Needle Injection Kit Components Figure 2 YEZTUGO Injection Steps for Withdrawal Needle Injection Kit Figure 1 Figure 2

6 ADVERSE REACTIONS The following adverse reactions are discussed in other sections of the labeling: Serious Injection Site Reactions with Improper Administration [see Warnings and Precautions (5.4) ]. Most common adverse reactions (incidence greater than or equal to 5%, all grades) are injection site reactions, headache, and nausea. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Gilead Sciences, Inc. at 1-800-GILEAD-5 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The primary safety assessment of YEZTUGO is based on data from two randomized, double-blind, active-controlled trials, PURPOSE 1 and PURPOSE 2, in which a total of 8616 adult and adolescent participants received YEZTUGO (N=4323), DESCOVY (emtricitabine [FTC]/tenofovir alafenamide [TAF]; N=2135) once daily, or TRUVADA (FTC/tenofovir disoproxil fumarate [TDF]; N=2158) once daily for HIV-1 PrEP. In PURPOSE 1, the median duration of exposure to YEZTUGO, DESCOVY, and TRUVADA was 43, 42, and 41 weeks, respectively. In PURPOSE 2, the median duration of exposure to both YEZTUGO and TRUVADA was 39 weeks. The most common adverse reactions (all Grades) reported in at least 5% of participants receiving YEZTUGO in either PURPOSE 1 or PURPOSE 2 were injection site reactions, headache, and nausea. In PURPOSE 1, <1% of participants in the groups receiving YEZTUGO, DESCOVY or TRUVADA, discontinued due to adverse events (all causality). In PURPOSE 2, 1% of participants in the group receiving YEZTUGO and <1% of participants receiving TRUVADA discontinued due to adverse events (all causality). Table 6 presents the frequency of adverse reactions (all Grades) in at least 2% of participants receiving YEZTUGO in either PURPOSE 1 or PURPOSE 2. Table 6. Adverse Drug Reactions (All Grades) Reported in ≥2% Frequencies of adverse reactions are based on all adverse events attributed to study drug (or to the procedure for injection site reactions) by the investigator. of Participants Receiving YEZTUGO in PURPOSE 1 or PURPOSE 2 PURPOSE 1 PURPOSE 2 Adverse Reaction YEZTUGO N=2140 TRUVADA Participants received placebo subcutaneous injections (polyethylene glycol 400). N=1070 YEZTUGO N=2183 TRUVADA N=1088 Injection Site Reactions 69% 34% 83% 69% Headache 7% 8% 2% 2% Nausea 5% 11% 2% 4% Dizziness 4% 6% <1% 1% Vomiting 4% 7% <1% 1% Diarrhea 4% 4% 2% 2% Injection-Associated Adverse Reactions Local Injection Site Reactions (ISRs) The most frequent adverse reactions associated with lenacapavir injection for subcutaneous use in PURPOSE 1 and PURPOSE 2 were ISRs. The most commonly reported ISRs (all grades) in at least 2% of participants who received YEZTUGO in either PURPOSE 1 or PURPOSE 2 are presented in Table 7 . PURPOSE 1 In PURPOSE 1, 69% of participants receiving YEZTUGO experienced ISRs, compared to 35% of participants receiving placebo injections (and DESCOVY or TRUVADA). Most participants who received YEZTUGO had mild (Grade 1, 50%) or moderate (Grade 2, 19%) severity ISRs. Grade 3 ISRs were reported in 4 (0.2%) participants, and included ulcer and nodule. YEZTUGO was discontinued due to ISRs in 4 (0.2%) participants. None of the ISRs were serious. The incidence of reported ISRs decreased with subsequent injections. Nodules: Injection site nodule was reported in 64% of participants who received YEZTUGO and resolved more slowly than other ISRs. The median duration of nodules associated with the first injections of YEZTUGO was 350 (interquartile range: 182, 470) days. The median of the maximum observed nodule diameter from each participant was 3.0 (interquartile range: 2.0, 3.5) cm. Other ISRs: The other ISRs reported in more than 2% of participants who received YEZTUGO were pain (31%), swelling (4%), induration (4%), and pruritus (2%). The median duration of induration, which resolved more slowly than most other ISRs, was 173 (interquartile range: 22, 267) days. The median duration of ISRs, excluding nodules and indurations, was 9 (interquartile range: 4 to 30) days. PURPOSE 2 In PURPOSE 2, 83% of participants receiving YEZTUGO experienced ISRs, compared to 69% of participants receiving placebo injections (and TRUVADA). Most participants had mild (Grade 1, 66%) or moderate (Grade 2, 17%) severity ISRs. Grade 3 ISRs were reported in 14 (0.6%) participants, and included ulcer, pain, erythema, edema, and dermatitis. YEZTUGO was discontinued due to ISRs in 26 (1.2%) participants. None of the ISRs were serious. The incidence of reported ISRs decreased with subsequent injections. Nodules: Injection site nodule was reported in 63% of participants who received YEZTUGO and resolved more slowly than other ISRs. The median duration of nodules associated with the first injections of YEZTUGO was 297 (interquartile range: 176, 423) days. The median of the maximum observed nodule diameter for each participant was 3.0 (interquartile range: 2.0, 4.0) cm. Other ISRs: The other ISRs reported in more than 2% of participants who received YEZTUGO were pain (56%), erythema (17%), induration (16%), swelling (7%), bruising (3%), pruritus (3%), and warmth (2%). The median duration of induration, which resolved more slowly than most other ISRs, was 151 (interquartile range: 15, 267) days. The median duration of ISRs, excluding nodules and indurations, was 4 (interquartile range: 2 to 8) days. Table 7. Injection Site Reactions (All Grades) Reported in ≥2% Frequencies are based on all injection site reactions attributed to study drug (or to the procedure) by the investigator. of Participants Receiving YEZTUGO in PURPOSE 1 or PURPOSE 2 PURPOSE 1 PURPOSE 2 Injection Site Reactions YEZTUGO N=2140 DESCOVY or TRUVADA Participants received placebo subcutaneous injections (polyethylene glycol 400). N=3205 YEZTUGO N=2183 TRUVADA N=1088 Nodule 64% 17% 63% 39% Pain 31% 24% 56% 53% Induration 4% <1% 16% 10% Swelling 4% 5% 7% 10% Pruritus 2% 1% 3% 3% Erythema 1% 1% 17% 19% Bruising <1% <1% 3% 4% Warmth <1% <1% 2% 2% Nodules and Indurations Dermatopathology In a separate clinical trial (CAPELLA) in participants with HIV-1 who received lenacapavir via subcutaneous injection, skin biopsies of injection site nodules or indurations revealed dermatopathological findings of foreign body inflammation or granulomatous response in some participants.

12.3 Pharmacokinetics The pharmacokinetic (PK) properties of lenacapavir are provided in Table 8 . The population PK parameter estimates of YEZTUGO after oral and subcutaneous administration to adults are provided in Table 9 . Similar exposures are achieved when YEZTUGO is administered subcutaneously in the abdomen or thigh. Table 8. Pharmacokinetic Properties of Lenacapavir Oral Subcutaneous Absorption % Absolute bioavailability 4 to 7 91 Values reflect absolute bioavailability following subcutaneous administration of the 927 mg dose. T max Values reflect administration of lenacapavir with or without food. 4 hours 77 to 84 days Subcutaneously administered lenacapavir forms a drug depot whereby lenacapavir is slowly released from the site of administration. Effect of Food Effect of low-fat meal (relative to fasting) Values refer to geometric mean ratio [low-fat meal/fasting] in PK parameters and (90% confidence interval). Low fat meal is approximately 400 kcal, 25% fat. AUC inf ratio 98.6 (58.2,167.2) - C max ratio 115.8 (55.4, 242.1) - Effect of high-fat meal (relative to fasting) Values refer to geometric mean ratio [high-fat meal/fasting] in PK parameters and (90% confidence interval). High fat meal is approximately 1000 kcal, 50% fat. AUC inf ratio 115.2 (72.0, 184.5) - C max ratio 145.2 (77.9, 270.5) - Distribution Steady state volume of distribution (L) 1657 % bound to human plasma proteins >98.5 Blood-to-plasma ratio 0.5 to 0.7 Values reflect the blood-to-plasma ratio of lenacapavir following a single dose intravenous administration of [ 14 C] lenacapavir through 336 hours postdose. Elimination Apparent t 1/2 10 to 12 days 8 to 12 weeks Clearance (L/h) 3.4 % of dose of unchanged drug in plasma Dosing in mass balance studies: single dose intravenous administration of [ 14 C] lenacapavir to participants. 69 Metabolism Metabolic pathway(s) CYP3A UGT1A1 (minor) Excretion Major routes of elimination Excretion of unchanged drug into feces Metabolized via oxidation, N-dealkylation, hydrogenation, amide hydrolysis, glucuronidation, hexose conjugation, pentose conjugation, and glutathione conjugation; via CYP3A and UGT1A1 and no single circulating metabolite accounted for >10% of plasma drug-related exposure. % of dose excreted in urine <1 % of dose excreted in feces (% unchanged) 76 (33) Table 9. Pharmacokinetic Parameters of Lenacapavir Following Oral and Subcutaneous Administration to Adult Participants Receiving YEZTUGO Parameter Mean (%CV) Day 1 to end of Month 6 Steady State CV = coefficient of variation C max (ng/mL) 73.8 (48.6) 82.4 (40.4) AUC tau (h•ng/mL) 188108 (41.0) 257334 (38.7) C trough (ng/mL) 27.0 (51.1) 36.9 (53.5) Specific Populations There were no clinically significant differences in the pharmacokinetics of lenacapavir based on age, sex assigned at birth, gender identity, ethnicity, race, body weight, severe renal impairment (creatinine clearance of 15 to less than 30 mL per minute, estimated by Cockroft-Gault method), or moderate hepatic impairment (Child-Pugh Class B). The effect of end-stage renal disease (including dialysis), or severe hepatic impairment (Child-Pugh Class C), on the pharmacokinetics of lenacapavir is unknown. As lenacapavir is greater than 98.5% protein bound, dialysis is not expected to alter exposures of lenacapavir [see Use in Specific Populations (8.6 , 8.7) ]. Pediatrics The population PK parameter estimates of YEZTUGO after oral and subcutaneous administration to adolescents (weighing at least 35 kg) are provided in Table 10 . Table 10. Pharmacokinetic Parameters of Lenacapavir Following Oral and Subcutaneous Administration to Adolescent Participants Receiving YEZTUGO Parameter Mean (%CV) Day 1 to end of Month 6 Steady State CV = coefficient of variation C max (ng/mL) 81.4 (50.8) 90.1 (41.7) AUC tau (h•ng/mL) 205420 (42.1) 279630 (39.3) C trough (ng/mL) 29.1 (51.4) 39.8 (53.7) Pregnancy Changes in lenacapavir exposures during pregnancy and postpartum in participants who received YEZTUGO were not considered clinically relevant compared to lenacapavir exposures observed in non-pregnant participants. Drug Interaction Studies Clinical Studies A clinical drug-drug interaction study indicated that lenacapavir is a substrate of CYP3A, P-gp, and UGT1A1. Table 11 summarizes the pharmacokinetic effects of other drugs on lenacapavir. Lenacapavir is a moderate inhibitor of CYP3A. Lenacapavir is an inhibitor of P-gp and BCRP but does not inhibit OATP. Table 12 summarizes the pharmacokinetic effects of lenacapavir on other drugs. Table 11. Effect of Other Drugs on Lenacapavir Single dose of lenacapavir 300 mg administered orally. Co-administered Drug Dose of Co-administered Drug (mg) Mean Ratio of Lenacapavir Pharmacokinetic Parameters (90% CI); No effect = 1.00 C max AUC Cobicistat (fed) (Inhibitor of CYP3A [strong] and P-gp) 150 once daily 2.10 (1.62, 2.72) 2.28 (1.75, 2.96) Darunavir / cobicistat (fed) (Inhibitor of CYP3A [strong] and inhibitor and inducer of P-gp) 800/150 once daily 2.30 (1.79, 2.95) 1.94 (1.50, 2.52) Voriconazole (fasted) (Inhibitor of CYP3A [strong]) 400 twice daily, 200 twice daily 400 mg loading dose twice daily for a day, followed by 200 mg maintenance dose twice daily. 1.09 (0.81, 1.47) 1.41 (1.10, 1.81) Atazanavir / cobicistat (fed) (Inhibitor of CYP3A [strong], UGT1A1, and P-gp) 300/150 once daily 6.60 (4.99, 8.73) 4.21 (3.19, 5.57) Rifampin (fasted) (Inducer of CYP3A [strong], P-gp, and UGT) 600 once daily 0.45 (0.34, 0.60) 0.16 (0.12, 0.20) Efavirenz (fasted) (Inducer of CYP3A [moderate] and P-gp) 600 once daily 0.64 (0.45, 0.92) 0.44 (0.32, 0.59) Famotidine (2 hours before, fasted) 40 once daily 1.01 (0.75, 1.34) 1.28 (1.00, 1.63) Table 12. Effect of Lenacapavir on Other Drugs Following 600 mg twice daily for 2 days, single 600 mg doses of lenacapavir were administered with each co-administered drug, resulting in lenacapavir exposures similar to or higher than those at the usual YEZTUGO dosing schedule [see Dosage and Administration (2.3) ] . Co-administered Drug Dose of Co-administered Drug (mg) Mean Ratio of Co-administered Drug Pharmacokinetic Parameters (90% CI) All No Effect Boundaries are 70% to 143%. ; No effect = 1.00 C max AUC Tenofovir alafenamide (fed) (substrate of P-gp) 25 single dose 1.24 (0.98, 1.58) 1.32 (1.09, 1.59) Tenofovir Tenofovir alafenamide is converted to tenofovir in vivo. (substrate of P-gp) 1.23 (1.05, 1.44) 1.47 (1.27, 1.71) Pitavastatin (simultaneous administration, fed) (substrate of OATP) 2 single dose 1.00 (0.84, 1.19) 1.11 (1.00, 1.25) Pitavastatin (3 days after lenacapavir, fed) (substrate of OATP) 2 single dose 0.85 (0.69, 1.05) 0.96 (0.87, 1.07) Rosuvastatin (fed) (substrate of BCRP and OATP) 5 single dose 1.57 (1.38, 1.80) 1.31 (1.19, 1.43) Midazolam (simultaneous administration, fed) (substrate of CYP3A) 2.5 single dose 1.94 (1.81, 2.08) 3.59 (3.30, 3.91) 1-hydroxymidazolam Major active metabolite of midazolam. (substrate of CYP3A) 0.54 (0.50, 0.59) 0.76 (0.72, 0.80) Midazolam (1 day after lenacapavir, fed) (substrate of CYP3A) 2.5 single dose 2.16 (2.02, 2.30) 4.08 (3.77, 4.41) 1-hydroxymidazolam (substrate of CYP3A) 0.52 (0.48, 0.57) 0.84 (0.80, 0.88) In Vitro Studies Lenacapavir is not a substrate, inducer, or inhibitor of CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, and CYP2D6. Lenacapavir is not an inducer of CYP3A. Lenacapavir is not an inhibitor of UGT1A1. Lenacapavir is not an inhibitor of OAT1, OAT3, OCT1, OCT2, MATE1, or MATE 2-K. Lenacapavir is not a substrate of BCRP, OATP1B1, or OATP1B3.