Truvada vs Descovy vs Generic Truvada
A question we often get here at PrEP207 is whether or not patients should switch from Truvada to Descovy. What medication one uses for PrEP is a decision that should be made in partnership with your healthcare provider, but here is some information that can help you make that decision.
A Little Background
Both Truvada and Descovy began as antiretroviral medications to treat HIV. Truvada was approved for HIV treatment by the Federal Food And Drug Administration (FDA) in 2004 and Descovy 2016, both in combination with other antiretroviral medications. In 2012, Truvada was approved by the FDA for pre-exposure prophylaxis (PrEP), and then a few years later in 2019, Descovy was also approved for PrEP.
Truvada's initial approval for PrEP came after the positive results from two 2 large clinical trials that included HIV-negative men and transgender women who have sex with men, as well as serodiscordant heterosexual couples. Since that time, there have been numerous other studies that confirmed that Truvada for PrEP works very well for cisgender gay and bisexual men, transgender women, intravenous drug users, and heterosexual couples.
Gilead Sciences, the maker of both Truvada and Descovy, has claimed that Descovy is safer and more effective than Truvada, and this has resulted in some confusion. These claims are based on one small study that only included gay and bisexual men and a small number of transgender women. This study simply can't be compared to other larger, more inclusive studies done on Truvada. What this means is that we have enough evidence to say that Descovy works as as Truvada in these populations, but not that it works better or works well for other populations.
So Is Descovy Really Better?
The answer is it is too soon to tell. The evidence tells us that Truvada and Descovy are equally effective for PrEP in gay and bisexual men and transgender women. We simply don't know enough about the potential safety benefits of Descovy over Truvada to say that one is works better than the other. That doesn't mean they are the same, however. Let's talk briefly about some of the differences.
Are They Really That Different?
To answer that let's start by taking a look under the hood. Both Truvada and Descovy use a combination of antiretroviral medications to prevent HIV and treat HIV, but there are some differences.
Truvada - Emtricitabine (200 mg) and Tenofovir disoproxil (300 mg)
Descovy - Emtricitabine (200 mg) and Tenofovir alafenamide (25 mg)
Both use the same dose of Emtricitabine, but the version of Tenofovir used is what is important. Tenofovir alafenamide (TAF for short) is absorbed more quickly than Tenofovir disoproxil (TDF for short). Faster absorption of TAF means higher levels of the active drug in the body. Why is that important? Smaller doses and lower drug levels in the blood means less exposure for the kidneys, bones, and other organs. That makes Descovy a better option for whom TDF is contraindicated due to a history of kidney problems or other pre-existing conditions.
There is also some difference in the side effects. While serious kidney problems and bone loss are rare with either drug, Descovy is less likely to impact the kidneys and bones. Truvada has a more favorable effect on blood fat levels and leads to less weight gain than Descovy.
What About Generics?
Teva Pharmaceutical Industries's generic version of Truvada became available in the U.S. in October of 2020 reducing the cost of PrEP. Does generic Truvada work as well as the brand name? Yes! The generic version is just as safe and effective as brand-name Truvada. Generic medications use the same active ingredients as brand-name which means they work the same, and have the same risks and benefits. Plus, the FDA requires drug companies to demonstrate that generic medications work equally as well as the brand name that it copies.
In brief, generic Truvada works just as well as the brand name. If you've been switched to a generic there is nothing to worry about. You are still getting the same level of protection.
Conclusion: Is Descovy Really Better?
The current evidence shows that Descovy works equally as well as Truvada for PrEP for gay and bisexual men and transgender women. More research needs to be done to determine how well it works for other populations, or if it is really more effective than Truvada.
Ignore the false ads you might have seen on social media. Descovy wasn't approved to replace Truvada because of the side effects. Both Descovy and Truvada has very low rates of side effects overall. If Truvada is working well for someone there is no reason to switch.
Since the launch of Teva's generics in the U.S., many insurance companies are requiring patients to switch from brand name Truvada and Descovy to generic Truvada. There is really nothing to worry about here, but don't hesitate to discuss any concerns you might have with your provider.
When speaking with your provider ask them what the benefits or advantages of using one drug over another. The San Francisco AIDS Foundation has a great side-by-side comparison of Descovy and Truvada for PrEP to help guide your conversation with your healthcare provider.
Got questions about Truvada versus Descovy? Wondering about generics? Need to talk to a provider? Wondering about starting PrEP? We can help. Call or text us: 207-553-PREP or email us firstname.lastname@example.org
This post was written with the generous assistance of Frannie Peabody Center's intern and Bowdoin College student Blaine Stevens.
Broussard, J. (2019, November). Side-by-side comparison: Truvada and Descovy for PrEP. https://www.sfaf.org/resource-library/side-by-side-comparison-truvada-and-descovy-for-prep/.
Buhl, L. (2020, January 27). Should All PrEP Users on Truvada Switch to Descovy? These Leading Docs Say, 'Not So Fast.'. https://www.thebodypro.com/article/should-prep-users-on-truvada-switch-to-descovy.
Center for Drug Evaluation and Research. (2018, June 18). Generic Drug Facts. U.S. Food and Drug Administration. https://www.fda.gov/drugs/generic-drugs/generic-drug-facts.
Highleyman, L. (2020, January 23). What's the difference between Truvada and Descovy for PrEP? https://www.poz.com/article/difference-truvada-descovy-prep.
Highleyman, L. (2020, October 12). First Generic Truvada Now Available in the United States. POZ. https://www.poz.com/article/first-generic-truvada-now-available-united-states.
Krakower, D. S. (2020). Tenofovir Alafenamide for HIV Preexposure Prophylaxis: What Can We DISCOVER About Its True Value? Annals of Internal Medicine, 172, 281–282. https://doi.org/10.7326/M19-3337
Shaw, M. L. (2020). In Debate Over PrEP, Researchers Raise Questions About Benefit vs Value. https://www.ajmc.com/view/in-debate-over-prep-researchers-raise-questions-about-benefit-vs-value-.