ADHERENCE AND PERSISTENCE IN US REAL-WORLD NEW PREP USERS: CABOTEGRAVIR VS EMTRICITABINE/TENOFOVIR ALAFENAMIDE
Author(s)
Aimee A. Metzner, PharmD1, Cathering Nguyen, MPH2, Farbod Alinezhad, MD, PhD, MPH3, Azeem Banatwala, BS, BA2, Leili Young-Xu, BA4, Gabrielle Herman, PharmD5, Dora Martinez, MD5, Maral DerSarkissian, PhD6.
1US Health Outcomes Director, ViiV Healthcare, Durham, NC, USA, 2Analysis Group, Inc, Los Angeles, CA, USA, 3Analysis Group, Inc., Boston, MA, USA, 4Analysis Group, Inc, Boston, MA, USA, 5ViiV Healthcare, Durham, NC, USA, 6Analysis Group, Inc., Los Angeles, CA, USA.
1US Health Outcomes Director, ViiV Healthcare, Durham, NC, USA, 2Analysis Group, Inc, Los Angeles, CA, USA, 3Analysis Group, Inc., Boston, MA, USA, 4Analysis Group, Inc, Boston, MA, USA, 5ViiV Healthcare, Durham, NC, USA, 6Analysis Group, Inc., Los Angeles, CA, USA.
OBJECTIVES: Cabotegravir long-acting (CAB-LA) was approved in the US for HIV-1 pre-exposure prophylaxis (PrEP) in December 2021. This analysis evaluated real-world adherence and persistence of CAB-LA compared to oral emtricitabine/tenofovir alafenamide (FTC/TAF) in new PrEP initiators.
METHODS: PrEPFACTS was a retrospective US cohort study using data from the Komodo Research Database (01/Dec/2020-30/Sept/2024). Individuals ≥12 years old with ≥1 CAB-LA injection or FTC/TAF fill (first claim defined index date), ≥12 months of continuous insurance eligibility before (baseline) and ≥6 months after index were included. Each individual in the CAB-LA cohort was exact-matched to 4 FTC/TAF users by age group and index quarter/year. Standardized mortality ratio (SMR) weighting was applied after matching to ensure comparability between cohorts. Adherence was described using proportion of days covered (PDC) from index to discontinuation, with PDC ≥90% considered adherent. Discontinuation was defined as a gap of ≥60 days since exhaustion of previous supply. Logistic and Cox regression models were used to determine the odds of adherence and risk of discontinuation, respectively. SMR-weighted Kaplan-Meier analysis was used to estimate days until discontinuation (persistence).
RESULTS: The CAB-LA cohort (N=842) had a median (interquartile range, IQR) age of 33 (27,44) with primarily commercial (49%) and Medicaid (47%) insurances. The FTC/TAF cohort (N=3368) had a median (IQR) age of 34 (26,44) with primarily commercial insurance (77%). After SMR-weighting, characteristics were similar between cohorts. A significantly larger proportion of the CAB-LA cohort was adherent compared to the SMR-weighted FTC/TAF cohort (89% vs 82%; OR 1.72 [95% confidence interval (CI):1.31,2.25]). Among those with ≥2 injections/fills, median persistence was 385 days (95%CI: 292,439) for CAB-LA and 219 days (95%CI: 197,252) for FTC/TAF. The risk of discontinuation was significantly lower in the CAB-LA cohort (hazard ratio 0.60 [95%CI: 0.53,0.68]).
CONCLUSIONS: New PrEP initiators using CAB-LA exhibit improved adherence/persistence relative to those using FTC/TAF.
METHODS: PrEPFACTS was a retrospective US cohort study using data from the Komodo Research Database (01/Dec/2020-30/Sept/2024). Individuals ≥12 years old with ≥1 CAB-LA injection or FTC/TAF fill (first claim defined index date), ≥12 months of continuous insurance eligibility before (baseline) and ≥6 months after index were included. Each individual in the CAB-LA cohort was exact-matched to 4 FTC/TAF users by age group and index quarter/year. Standardized mortality ratio (SMR) weighting was applied after matching to ensure comparability between cohorts. Adherence was described using proportion of days covered (PDC) from index to discontinuation, with PDC ≥90% considered adherent. Discontinuation was defined as a gap of ≥60 days since exhaustion of previous supply. Logistic and Cox regression models were used to determine the odds of adherence and risk of discontinuation, respectively. SMR-weighted Kaplan-Meier analysis was used to estimate days until discontinuation (persistence).
RESULTS: The CAB-LA cohort (N=842) had a median (interquartile range, IQR) age of 33 (27,44) with primarily commercial (49%) and Medicaid (47%) insurances. The FTC/TAF cohort (N=3368) had a median (IQR) age of 34 (26,44) with primarily commercial insurance (77%). After SMR-weighting, characteristics were similar between cohorts. A significantly larger proportion of the CAB-LA cohort was adherent compared to the SMR-weighted FTC/TAF cohort (89% vs 82%; OR 1.72 [95% confidence interval (CI):1.31,2.25]). Among those with ≥2 injections/fills, median persistence was 385 days (95%CI: 292,439) for CAB-LA and 219 days (95%CI: 197,252) for FTC/TAF. The risk of discontinuation was significantly lower in the CAB-LA cohort (hazard ratio 0.60 [95%CI: 0.53,0.68]).
CONCLUSIONS: New PrEP initiators using CAB-LA exhibit improved adherence/persistence relative to those using FTC/TAF.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR85
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
SDC: Infectious Disease (non-vaccine), SDC: Reproductive & Sexual Health