Persistence in treatment-experienced people with HIV switching anti-retroviral therapy regimens since 2018
Creators: name: Colson, Amy
name: Chastek, Benjamin
name: Gruber, Joshua
name: Majethia, Sunil
name: Zachry, Woodie
name: Mezzio, Dylan
name: Rock, Marvin
name: Anderson, Amy
name: Cohen, Joshua
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Pharmacology
subject: Biotechnology
subject: Environmental Sciences not elsewhere classified
subject: Biological Sciences not elsewhere classified
subject: Cancer
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology

description: <b>Aim:</b> This study examined antiretroviral therapy (ART) persistence in treatment-experienced people with HIV (PWH) who switched or restarted guideline-recommended, integrase strand transfer inhibitor (INSTI)-based multi-tablet (MTR) and single tablet regimens (STR). <b>Methods:</b> Claims data from the Optum Research Database (01/01/2010-03/31/2020) was used to identify lines of therapy (LOTs) for treatment-experienced adults who switched or restarted INSTI-based regimens between 01/01/2018-12/31/2019, excluding drugs approved late in the study. LOT duration and reason for LOT cessation were compared for INSTI-based MTR vs. STR and among individual INSTI-based regimens. Adjusted hazard ratios (HR) were examined following propensity score weighting to control for differences. <b>Results:</b> In the sample, 3625 started STRs and 626 started MTRs including: bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (STR) (64.2%), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) (STR) (21.1%), dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF) (MTR) (12.7%) and dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF) (MTR) (2.1%). Discontinuation (11 vs. 15%, <i>p</i> = 0.003) and switching (7 vs. 25%, <i>p</i> &lt; 0.001) were less common for STRs vs. MTRs. After adjusting, discontinuation and switching rates were higher for DTG/ABC/3TC, DTG + FTC/TAF and DTG + FTC/TDF compared with B/F/TAF. <b>Conclusion:</b> PWH treated with INSTI-based STRs discontinued or switched regimens less than those on MTRs. B/F/TAF was associated with less switching and discontinuation. People with HIV (PWH) can get their medicine in a single pill or in multiple different pills. This study examined patients who were already taking medication and were switching to or restarting different single-tablet or muti-tablet medication regimens. We used data from health insurance claims to see how long patients took their medication and whether they continued their medication and looked to see if there were differences between those who were taking STRs and MTRS. We also examined differences between specific regimens. We found that PWH treated with STRs discontinued or switched regimens less than those on MTRs. One specific regimen, bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), was also found to be associated with less switching and discontinuation. This study assesses persistence in treatment-experienced people with HIV (PWH) treated with different Department of Health and Human Services (DHHS) guideline recommended integrase strand transfer inhibitor (INSTI)-based single tablet regimens (STRs) or multi-tablet regimens (MTRs). Insurance claims data from the Optum Research Database (01/01/2010-03/31/2020) was used to identify lines of therapy (LOTs) for treatment-experienced adults who switched or restarted INSTI-based regimens between 01/01/2018-12/31/2019. Among INSTI-based STRs and MTRs, LOT duration and reason for LOT cessation were compared. Differences between specific regimens were also compared. To adjust for differences between groups, adjusted hazard ratios (HR) from Cox proportional hazard models were examined. We found that rates of discontinuation (11 vs. 15%, <i>p</i> = 0.003) and switching (7 vs. 25%, <i>p</i> &lt; 0.001) were both less frequent for STRs when compared with MTRs. After adjusting, we found that both discontinuation and switching rates were higher for the regimens dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) (STR) and dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF) and dolutegravir + emtricitabine/tenofovir disoproxil fumarate DTG + FTC/TDF (both MTRs) compared with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). Among treatment experienced PWH treated with INSTI-based regimens, those treated with STRs discontinued or switched regimens less than those on MTRs. Compared with other regimens (both STRS and MTRs) B/F/TAF was associated with less switching and discontinuation.