Background
Cabotegravir/rilpivirine (CAB/RPV), the first complete long-acting injectable (LAI) antiretroviral therapy (ART) regimen, was approved by the FDA in January 2021 and offers a convenient monthly to bimonthly alternative to daily oral ART with the potential to improve adherence and viral suppression. To understand the degree of uptake of CAB/RPV, we assessed trends of and characteristics associated with prescriptions for injectable CAB/RPV, compared with oral ART.
Methods
Using HealthVerity Marketplace™, a national administrative dataset consisting of medical and pharmacy open/closed claims from public and private entities, inpatient and outpatient billing data, and laboratory test results from all US states and major payer types, we estimated the number of persons with HIV (PWH) prescribed oral ART regimens and CAB/RPV with closed claims, by month from January 2021 to August 2023. Among PWH prescribed ART, we assessed demographic characteristics stratified by prescription for oral ART or CAB/RPV. Patient- and prescription-level characteristics were compared across the two treatment groups using chi-squared and two-proportion Z-tests.
Results
During the study period, 208,196 PWH were prescribed only oral ART for a total of 3,469,191 prescriptions, while 4,087 unique PWH were prescribed CAB/RPV for a total of 21,698 prescriptions. The number of prescriptions for CAB/RPV increased from 1,410 in 2021 (January to December 2021) to 11,051 in 2022 (January to December 2022). From January 2023 to August 2023, there were 9,237 prescriptions for CAB/RPV. Older age groups (55+) were less frequently prescribed CAB/RPV compared with oral ART (16.0% vs 21.6%; p <0.001). Substance use disorder diagnoses were more common among persons prescribed CAB/RPV than oral ART (47.7% vs. 40.1%; p <0.001). Southern regions (40.4% vs. 33.3%) and commercial payers (32.1% vs. 13.8%) were more common among oral ART prescriptions than CAB/RPV (p <0.001). However, Medicaid payers were more common among prescriptions for CAB/RPV (76.2% v. 53.8%; p <0.001).
Conclusions
Relatively few PWH were prescribed CAB/RPV since its recent approval, however the proportion is increasing. Better understanding is needed of reasons for modest CAB/RPV uptake overall, including possibly cost and operational barriers to its implementation. Studying the factors associated with CAB-RPV use among specific regions in the US, such as the South, and in persons aging with HIV or those with adherence challenges, can inform implementation efforts.