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Benson P, Kuretski J, Donovan C, Harper G, Merrill D, Metzner AA, Mycock K, Wallis H, Brogan AP, Patarroyo J, Oglesby A. Real-World Effectiveness of Dolutegravir/Lamivudine in People With HIV-1 in Test-and-Treat Settings or With High Baseline Viral Loads: TANDEM Study Subgroup Analyses. Infect Dis Ther 2024; 13:875-889. [PMID: 38570444 PMCID: PMC11058154 DOI: 10.1007/s40121-024-00950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Dolutegravir/lamivudine (DTG/3TC) was first approved by the US Food and Drug Administration in 2019 for the treatment of antiretroviral therapy (ART)-naive people with HIV-1 based on results from the pivotal GEMINI-1/GEMINI-2 trials. Around that time, immediate initiation of treatment upon diagnosis was recommended in the US Department of Health and Human Services guidelines. Here we report results from 126 treatment-naive people with HIV-1 who initiated DTG/3TC as part of a test-and-treat strategy (n = 61) or with high baseline viral loads (HIV-1 RNA ≥ 100,000 copies/ml; n = 16) from the TANDEM study. METHODS TANDEM was a US-based, retrospective chart review study that included a cohort of 126 individuals aged ≥ 18 years with no prior history of ART who initiated DTG/3TC before September 30, 2020, and had ≥ 6 months of follow-up. Test-and-treat was defined as ART initiation shortly after diagnosis without available viral load, CD4 + cell count, or HIV-1 resistance data. Outcomes included virologic suppression (HIV-1 RNA < 50 copies/ml; overall and by baseline viral load) and discontinuations. Analyses were descriptive. RESULTS Among 61 individuals who initiated DTG/3TC in a test-and-treat setting (median [interquartile range (IQR)] treatment duration, 1.3 [0.9-1.7] years), 57 (93%) achieved virologic suppression, and 51 (84%) remained suppressed; 1 (< 1%) individual discontinued DTG/3TC due to persistent low-level viremia. The most common healthcare provider (HCP)-reported reason for initiating DTG/3TC was avoidance of long-term toxicities among individuals in the test-and-treat subgroup. Of 16 treatment-naive individuals with high baseline viral loads (median [IQR] treatment duration, 100,000-250,000 copies/ml: 1.2 [0.8-1.8] years; > 250,000 copies/ml: 1.0 [0.7-1.1] years), 14 (88%) achieved virologic suppression, 13 (81%) remained suppressed, and none discontinued DTG/3TC. Patient preference was the most common HCP-reported reason for initiating DTG/3TC in this subgroup. CONCLUSIONS Results demonstrate real-world effectiveness of DTG/3TC, with few discontinuations, in people with HIV-1 in test-and-treat settings or with high baseline viral loads.
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Affiliation(s)
- Paul Benson
- Be Well Medical Center, 1964 W Eleven Mile Road, Berkley, MI, 48072, USA
| | - Jennifer Kuretski
- Midway Specialty Care Center, 1515 N Flagler Drive, Suite 200, West Palm Beach, FL, 33401, USA
| | - Cynthia Donovan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Gavin Harper
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Deanna Merrill
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Aimee A Metzner
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA.
| | - Katie Mycock
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Hannah Wallis
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Andrew P Brogan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Jimena Patarroyo
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Alan Oglesby
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
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Schneider S, Blick G, Burke C, Ward D, Benson P, Felizarta F, Green D, Donovan C, Harper G, Merrill D, Metzner AA, Mycock K, Wallis H, Patarroyo J, Brogan AP, Oglesby A. Two-Drug Regimens Dolutegravir/Lamivudine and Dolutegravir/Rilpivirine Are Effective with Few Discontinuations in US Real-World Settings: Results from the TANDEM Study. Infect Dis Ther 2024; 13:891-906. [PMID: 38570443 PMCID: PMC11058742 DOI: 10.1007/s40121-024-00961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Dolutegravir/lamivudine (DTG/3TC) and dolutegravir/rilpivirine (DTG/RPV) are fixed-dose, complete, single-tablet, two-drug regimens (2DRs) indicated for HIV-1. DTG/3TC is approved for antiretroviral therapy (ART)-naive people with HIV-1 and virologically suppressed individuals to replace current ART; DTG/RPV is indicated for virologically suppressed individuals as a switch option. Virologic efficacy and effectiveness of these DTG-based 2DRs have been demonstrated in phase 3 clinical trials and real-world cohorts, primarily from Europe. This study characterized real-world use of DTG-based 2DRs for HIV-1 treatment in the USA. METHODS TANDEM was a retrospective medical chart review across 24 US sites. Individuals aged ≥ 18 years who initiated DTG/3TC or DTG/RPV before September 30, 2020, with ≥ 6 months of follow-up were included. One cohort included ART-naive people who initiated DTG/3TC (n = 126), and two other cohorts included virologically suppressed (HIV-1 RNA < 50 copies/mL) people on stable ART regimens for ≥ 3 months before switch to either DTG/3TC (n = 192) or DTG/RPV (n = 151). Clinical characteristics, treatment history, and outcomes are described. RESULTS Virologically suppressed individuals were older than those who were ART-naive, and the ART-naive cohort had higher proportions of individuals assigned male at birth and of Hispanic ethnicity. The most common healthcare provider-reported reason for choosing a DTG-based 2DR was avoidance of long-term toxicities (25-33% across cohorts), followed by simplification/streamlining of treatment. Among ART-naive people on DTG/3TC, 94% achieved virologic suppression after initiation, and 83% maintained suppression at last follow-up; discontinuation rate was < 1%. Among cohorts who switched to DTG-based 2DRs, 96% maintained virologic suppression on DTG/3TC and 93% on DTG/RPV; 2% on DTG/3TC and 3% on DTG/RPV discontinued. CONCLUSION Motivation for selecting DTG-based 2DRs was primarily driven by a desire to avoid or manage toxicities and simplify treatment. Results demonstrate that DTG/3TC and DTG/RPV are effective in real-world settings, with few discontinuations, reflecting data from clinical trials.
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Affiliation(s)
- Stefan Schneider
- Long Beach Education and Research Consultants, 1040 Elm Avenue, #303, Long Beach, CA, 90813, USA
| | - Gary Blick
- Health Care Advocates International, 2595 Main Street, 2nd Floor, Stratford, CT, 06615, USA
| | - Christina Burke
- CAN Community Health, 3251 3rd Avenue N, St Petersburg, FL, 33713, USA
| | - Douglas Ward
- Dupont Circle Physicians Group, 1145 19th Street NW, Suite 200, Washington, DC, 20009, USA
| | - Paul Benson
- Be Well Medical Center, 1964 W Eleven Mile Road, Berkley, MI, 48072, USA
| | - Franco Felizarta
- Bakersfield Family Medical Center, 4580 California Avenue, Bakersfield, CA, 93309, USA
| | - Dallas Green
- AHF Healthcare Center-Kinder, 3661 S Miami Avenue, Suite 806, Miami, FL, 33133, USA
| | - Cynthia Donovan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Gavin Harper
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Deanna Merrill
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Aimee A Metzner
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Katie Mycock
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Hannah Wallis
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Jimena Patarroyo
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Andrew P Brogan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Alan Oglesby
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA.
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Brogan AJ, Davis AE, Mellott CE, Fraysse J, Metzner AA, Oglesby AK. Cost-effectiveness of Cabotegravir Long-Acting for HIV Pre-exposure Prophylaxis in the United States. Pharmacoeconomics 2024; 42:447-461. [PMID: 38267806 PMCID: PMC10937761 DOI: 10.1007/s40273-023-01342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Cabotegravir long-acting (CAB-LA) administered every 2 months was approved in the USA as pre-exposure prophylaxis (PrEP) for individuals at risk of acquiring human immunodeficiency virus (HIV)-1 infection based on the HIV Prevention Trials Network (HPTN) 083 and HPTN 084 clinical trials, which demonstrated superior reduction in HIV-1 acquisition compared with daily oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in men who have sex with men (MSM), transgender women (TGW), and cisgender women. A decision-analytic model was developed to assess the lifetime cost-effectiveness of initiating CAB-LA versus generic oral FTC/TDF for HIV PrEP in the USA from a healthcare sector perspective. METHODS PrEP-eligible adults entered the Markov model receiving CAB-LA or FTC/TDF and could continue initial PrEP, transition to a second PrEP option, or discontinue PrEP over time. Efficacy was taken from the HPTN 083 and HPTN 084 clinical trials. Individuals who acquired HIV-1 infection incurred lifetime HIV-related costs, could transmit HIV onwards, and could develop PrEP-related resistance mutations. Input parameter values were obtained from public and published sources. Model outcomes were discounted at 3%. RESULTS The model estimated that the CAB-LA pathway prevented 4.5 more primary and secondary HIV-1 infections per 100 PrEP users than the oral PrEP pathway, which yielded 0.2 fewer quality-adjusted life-years (QALYs) lost per person. Additional per-person lifetime costs were $9476 (2022 US dollars), resulting in an incremental cost-effectiveness ratio of $46,843 per QALY gained. Results remained consistent in sensitivity and scenario analyses, including in underserved populations with low oral PrEP usage. CONCLUSIONS Our analysis suggests that initiating CAB-LA for PrEP is cost-effective versus generic daily oral FTC/TDF for individuals at risk of acquiring HIV-1 infection.
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Affiliation(s)
- Anita J Brogan
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Ashley E Davis
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Claire E Mellott
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
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