BIC LEN HIV Treatment: New Single-Tablet Regimen Shows Promising Results in ARTISTRY Trials
BIC/LEN HIV Treatment Maintains Suppression in Switch Studies
Phase 3 results from Gilead Sciences’ ARTISTRY-1 and ARTISTRY-2 trials, presented at the 2026 Conference on Retroviruses and Opportunistic Infections (CROI) and published in The Lancet, demonstrate that the investigational BIC LEN HIV treatment of bictegravir 75 mg/lenacapavir 50 mg (BIC/LEN) maintained virological suppression in virologically suppressed adults with HIV-1 who switched from complex multi-tablet regimens or from BIKTARVY (bictegravir/emtricitabine/tenofovir alafenamide; B/F/TAF). BIC LEN HIV treatment showed noninferiority to comparators, with low rates of virologic failure (0.8% in ARTISTRY-1 versus 1.1% for complex regimens; 1.3% in ARTISTRY-2 versus 1.0% for BIKTARVY), stable CD4 counts, and improvements in patient-reported satisfaction and lipid profiles where applicable. The regimen was generally well tolerated, supporting its potential as a convenient once-daily option combining bictegravir, an integrase strand transfer inhibitor (INSTI) with a high resistance barrier, and lenacapavir, a first-in-class capsid inhibitor.
Switches from Complex Regimens Yield Lipid Gains
In ARTISTRY-1, BIC LEN HIV treatment demonstrated noninferiority to complex multi-tablet regimens (2-11 pills daily at baseline, with ~40% dosed more than once daily) for maintaining HIV-1 RNA <50 copies/mL at Week 48, per the US Food and Drug Administration (FDA)-defined snapshot algorithm, with virologic failure rates of 0.8% versus 1.1%. Supporting data included no emergent resistance, stable CD4 counts, and favorable changes such as a median -15 mg/dL reduction in total cholesterol (versus +2 mg/dL in the control group) and a mean 7-point increase in HIV Treatment Satisfaction Questionnaire (HIVTSQs) scores. ARTISTRY-2 confirmed noninferiority to BIKTARVY (1.3% versus 1.0% virologic failure), with stable body mass index, minimal resistance (one isolated integrase substitution without phenotypic impact in BIC/LEN; none in capsid), and comparable tolerability (drug-related adverse events at 10.4% for BIC/LEN versus 12.0% for BIKTARVY; discontinuations due to adverse events at 1.6% in both). These findings highlight BIC/LEN’s potential to address barriers like pill burden, pre-existing resistance, and drug interactions, transitioning seamlessly to its safety profile, where drug-related adverse events were 14.3% in ARTISTRY-1 (BIC/LEN) versus 1.6% (control), with rare serious events (0.3%) and discontinuations (1.6%).
Trial Designs Target Real-World HIV Challenges
ARTISTRY-1 (NCT05502341), a multicenter Phase 2/3 randomized open-label trial, enrolled virologically suppressed adults on complex regimens and randomized them 2:1 to BIC/LEN or continuation of baseline therapy, with the primary endpoint of HIV-1 RNA ≥50 copies/mL at Week 48 per FDA snapshot, alongside secondary endpoints like virologic suppression rates, CD4 changes, and treatment-emergent adverse events. Complementing this, ARTISTRY-2 (NCT06333808), a double-blind Phase 3 trial, randomized BIKTARVY-treated suppressed patients 2:1 to BIC/LEN or continued BIKTARVY, using identical primary and key secondary endpoints. These designs targeted real-world challenges such as intolerance or contraindications to guideline-recommended single-tablet regimens, providing robust evidence through late-breaker presentations at CROI 2026 and topline results from late 2025, which directly underpin the efficacy and safety claims while paving the way for regulatory submissions.
BIC/LEN Positions for Adherence and Cost Savings
The ARTISTRY trial outcomes position BIC LEN HIV treatment as a potential differentiator for HIV, offering a simplified single-tablet alternative that could enhance adherence and reduce healthcare resource utilization compared to multi-tablet regimens, particularly for patients with resistance or interaction issues. Its noninferiority to BIKTARVY—alongside lipid improvements and satisfaction gains—may support reimbursement decisions, potentially lowering long-term costs through fewer virologic failures and better patient retention, especially as lenacapavir’s multi-stage capsid inhibition complements INSTIs without cross-resistance. Reflecting broader trends in long-acting HIV therapies, these findings could influence payer negotiations by demonstrating outcomes comparable to established standards, fostering competition in the single-tablet regimen space and aiding global access efforts amid Gilead’s innovation pipeline.
