VIIV HEALTHCARE ANNOUNCES POSITIVE DATA DEMONSTRATING LONG-ACTING INJECTABLE CABENUVA (CABOTEGRAVIR, RILPIVIRINE) IS AS EFFECTIVE AS DAILY ORAL BIKTARVY (BIC/FTC/TAF) FOR THE TREATMENT OF HIV-1
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- 12-month findings from the SOLAR study showed that the every-two-month regimen of CAB+RPV LA demonstrated non-inferior efficacy compared to continuation of daily oral BIC/FTC/TAF
- 90% of participants who switched from BIC/FTC/TAF to CAB+RPV LA preferred the complete long-acting regimen to daily pills
London, 23 February 2023 – ViiV Healthcare, the global specialist HIV company majority owned by GSK, with Pfizer and Shionogi as shareholders, announced yesterday positive 12-month findings from the SOLAR study. SOLAR is the first head-to-head, Phase IIIb study of the first and only complete long-acting injectable regimen Cabenuva (cabotegravir, rilpivirine [CAB+RPV LA]) compared against complete daily oral regimen Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide [BIC/FTC/TAF]).
Study findings showed that CAB+RPV LA dosed every two months achieved the primary endpoint of non-inferior virologic efficacy versus daily oral BIC/FTC/TAF, while 90% of participants who switched to CAB+RPV LA from BIC/FTC/TAF, and who completed a survey (n=425), preferred the long-acting regimen. Switching to CAB+RPV LA from BIC/FTC/TAF during the SOLAR study was efficacious, well-tolerated, and improved treatment satisfaction from baseline based on adjusted HIV Treatment Satisfaction Questionnaire status version scores (HIVTSQs). These data were presented at the 30th Conference on Retroviruses and Opportunistic Infections (CROI), being held in Seattle, Washington.
Harmony P. Garges, M.D., MPH, Chief Medical Officer at ViiV Healthcare, said: “The treatment needs of people living with HIV are changing, with ample evidence on patient preference suggesting some people living with HIV can experience challenges with taking daily oral treatment for HIV. It’s essential that people living with HIV have treatment options that can help alleviate these burdens and we believe that complete long-acting regimens are here to help address some of those challenges today. We are confident that cabotegravir, as part of a complete long-acting regimen, is a cornerstone for the long-acting treatment era in HIV medicine, as supported by its strong and durable efficacy, safety, and by the fact that 90% of participants in this study who completed a survey preferred a long-acting regimen after switching from their daily oral pills.”
In the SOLAR study, 670 participants who were virally supressed and taking BIC/FTC/TAF were randomised 2:1 to switch to CAB+RPV LA administered every two months (447 participants) or continue taking daily oral BIC/FTC/TAF (223 participants). The SOLAR study met its primary endpoint at Month 12, when CAB+RPV LA demonstrated non-inferior efficacy versus daily oral BIC/FTC/TAF based on the proportion of participants with HIV-1 RNA ≥50 c/mL using the FDA Snapshot algorithm and a 4% non-inferiority margin (mITT-E; CAB+RPV LA: 5/447 [1%], BIC/FTC/TAF: 1/223 [<1%], adjusted difference: 0.7%, 95% confidence interval [-0.7, 2.0]). The study found that rates of virologic suppression (HIV-1 RNA <50 c/mL) were similar between treatment arms (CAB+RPV LA: 403/447 [90%], BIC/FTC/TAF: 207/223 [93%], adjusted difference: -2.7%, 95% confidence interval [-7.0, 1.7]). Non-inferior virologic outcomes were confirmed in the ITT-E and Per Protocol (PP) analyses.
At the beginning of the study, 47% of participants reported always or often experiencing one or more challenges with taking their daily therapy, including “being worried about people unintentionally discovering their HIV status,” “being worried about forgetting to take their HIV medication,” or “feeling that taking their HIV medication was an uncomfortable reminder of their HIV status.” Mean treatment satisfaction scores (HIVTSQs) improved significantly at the conclusion of the study for participants taking CAB+RPV LA (+3.36) compared to BIC/FTC/TAF (-1.59) from baseline (CAB+RPV LA: 57.88, BIC/FTC/TAF: 58.38) (p<0.001). 90% of participants who switched to CAB+RPV LA and completed the survey, preferred long-acting therapy versus daily oral pills (n=382/425), with the top five reasons for preferring long-acting therapy being:
- I don’t have to worry as much about remembering to take HIV medication every day
- It is more convenient for me to receive injections every 2 months
- I do not have to carry my HIV medication with me
- I do not have to think about my HIV status every day
- I do not have to worry about others seeing or finding my HIV pills
Confirmed virologic failure (CVF) was infrequent. Two participants (0.4%) in the mITT-E analysis and one additional participant in the ITT-E analysis who received CAB+RPV LA, developed CVF, with subsequent identification of resistance-associated mutations (RAMs) to NNRTI and integrase inhibitors. No participant in the BIC/FTC/TAF treatment arm developed CVF.
Treatment with CAB+RPV LA and BIC/FTC/TAF were both well-tolerated. With the exclusion of injection site reaction (ISRs), adverse events (AEs) and serious adverse events (SAEs) were comparable between arms, although drug-related AEs were more frequent in the long-acting (the switch) arm (20% vs <1%). The most commonly reported drug-related AEs in the LA arm were pyrexia (3%), headache (2%), fatigue (2%), and diarrhoea (2%). In the BIC/FTC/TAF arm, the two drug-related AEs reported were weight gain (<1%) and abnormal hepatic function (<1%). Most ISRs in the long-acting arm were Grade 1 or 2 (98%) and short lived (median 3 days), with few participants discontinuing due to injection-related reasons (2%). More participants in the long-acting arm withdrew due to AEs (6% vs <1%).
Moti N. Ramgopal of the Midway Immunology and Research Center, Fort Pierce, Florida and Principal Investigator for SOLAR, said: “There are many people living with HIV who are virally suppressed but experience challenges taking a daily oral pill, including fears of accidentally disclosing their HIV status due to discovery of their medicine. The SOLAR findings demonstrate that CAB+RPV LA administered every two months is as effective as BIC/FTC/TAF, while also addressing some important challenges associated with taking daily HIV treatment. These findings raise the critical reminder that healthcare providers who prescribe HIV medicines should identify and incorporate patient preferences when making treatment recommendations, in addition to standard efficacy and safety data, to ensure that people living with HIV have the best treatment option for their needs.”
ViiV Healthcare’s cabotegravir in combination with rilpivirine, a product of Janssen Sciences Ireland Unlimited Company, one of the Janssen Pharmaceutical Companies of Johnson & Johnson was co-developed as part of a collaboration with Janssen and builds on ViiV Healthcare’s industry-leading long-acting portfolio that is centred on delivering innovative medicines for the HIV community. The complete long-acting regimen of CAB+RPV LA is licensed in Canada, USA and Australia under the brand name Cabenuva, and in Europe and Japan as Vocabria (cabotegravir injection and tablets) and Rekambys (rilpivirine long-acting injectable suspension). Additional findings and analyses from the SOLAR study, including additional data on patient reported outcomes, will be presented at future congresses.
SOLAR (NCT04542070) is a Phase IIIb, randomised (2:1), open-label, multicentre, non-inferiority (NI) study assessing switching virologically suppressed adults to CAB+RPV LA (with/without oral lead-in [OLI]) dosed every two months versus continuing BIC/FTC/TAF. The primary analysis was based on the pre-specified modified intent-to-treat exposed (mITT-E) population (n=11 excluded from the ITT-E for major protocol deviations). The primary endpoint was the proportion with plasma HIV-1 RNA ≥50 c/mL (FDA Snapshot, 4% NI margin) at M11 (LA without oral lead-in)/M12 (LA with oral lead-in and BIC/FTC/TAF). Other endpoints were the proportion with plasma HIV-1 RNA <50 c/mL (FDA Snapshot, -12% NI margin), incidence of confirmed virologic failure (CVF; 2 consecutive HIV-1 RNA ≥200 c/mL), safety, tolerability, treatment satisfaction (HIVTSQs), and preference.
About Cabenuva (cabotegravir, rilpivirine)
Cabenuva is indicated as a complete regimen for the treatment of HIV-1 infection in adults to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA <50 c/ml) on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine.
The complete regimen combines the integrase strand transfer inhibitor (INSTI) cabotegravir, developed by ViiV Healthcare, with rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI) developed by Janssen Sciences Ireland Unlimited Company. Rilpivirine is approved in the US as a 25mg tablet taken once a day to treat HIV-1 in combination with other antiretroviral agents in antiretroviral treatment-naïve patients 12 years of age and older and weighing at least 35kg with a viral load ≤100,000 HIV RNA c/ml.
INSTIs inhibit HIV replication by preventing the viral DNA from integrating into the genetic material of human immune cells (T-cells). This step is essential in the HIV replication cycle and is also responsible for establishing chronic disease. Rilpivirine is an NNRTI that works by interfering with an enzyme called reverse transcriptase, which stops the virus from multiplying.
Trademarks are owned by or licensed to the ViiV Healthcare group of companies.
Important Safety Information for Cabenuva (cabotegravir 200mg/mL; rilpivirine 300mg/mL) extended-release injectable suspensions
Cabenuva is indicated as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per ml) on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine.
- Do not use Cabenuva in patients with previous hypersensitivity reaction to cabotegravir or rilpivirine
- Do not use Cabenuva in patients receiving carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, systemic dexamethasone (>1 dose), and St John’s wort
WARNINGS AND PRECAUTIONS
- Hypersensitivity reactions, including cases of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), have been reported during postmarketing experience with rilpivirine-containing regimens. While some skin reactions were accompanied by constitutional symptoms such as fever, other skin reactions were associated with organ dysfunctions, including elevations in hepatic serum biochemistries
- Serious or severe hypersensitivity reactions have been reported in association with other integrase inhibitors and could occur with Cabenuva
- Discontinue Cabenuva immediately if signs or symptoms of hypersensitivity reactions develop. Clinical status, including liver transaminases, should be monitored and appropriate therapy initiated. Prescribe the oral lead-in prior to administration of Cabenuva to help identify patients who may be at risk of a hypersensitivity reaction
- Serious post-injection reactions (reported in less than 1% of subjects) were reported within minutes after the injection of rilpivirine, including dyspnea, bronchospasm, agitation, abdominal cramping, rash/urticaria, dizziness, flushing, sweating, oral numbness, changes in blood pressure, and pain (e.g., back and chest). These events may have been associated with inadvertent (partial) intravenous administration and began to resolve within a few minutes after the injection
- Carefully follow the Instructions for Use when preparing and administering Cabenuva. The suspensions should be injected slowly via intramuscular injection and avoid accidental intravenous administration. Observe patients briefly (approximately 10 minutes) after the injection. If a post-injection reaction occurs, monitor and treat as clinically indicated
- Hepatotoxicity has been reported in patients receiving cabotegravir or rilpivirine with or without known pre-existing hepatic disease or identifiable risk factors
- Patients with underlying liver disease or marked elevations in transaminases prior to treatment may be at increased risk for worsening or development of transaminase elevations
- Monitoring of liver chemistries is recommended and treatment with Cabenuva should be discontinued if hepatotoxicity is suspected
- Depressive disorders (including depressed mood, depression, major depression, mood altered, mood swings, dysphoria, negative thoughts, suicidal ideation or attempt) have been reported with Cabenuva or the individual products
- Promptly evaluate patients with depressive symptoms
Risk of Adverse Reactions or Loss of Virologic Response Due to Drug Interactions:
- The concomitant use of Cabenuva and other drugs may result in known or potentially significant drug interactions (see Contraindications and Drug Interactions)
- Rilpivirine doses 3 and 12 times higher than the recommended oral dosage can prolong the QTc interval
- Cabenuva should be used with caution in combination with drugs with a known risk of Torsade de Pointes
Long-Acting Properties and Potential Associated Risks with Cabenuva:
- Residual concentrations of cabotegravir and rilpivirine may remain in the systemic circulation of patients for prolonged periods (up to 12 months or longer). Select appropriate patients who agree to the required monthly or every-2-month injection dosing schedule because non-adherence could lead to loss of virologic response and development of resistance
- To minimize the potential risk of developing viral resistance, it is essential to initiate an alternative, fully suppressive antiretroviral regimen no later than 1 month after the final injection doses of Cabenuva when dosed monthly and no later than 2 months after the final injections of Cabenuva when dosed every 2 months. If virologic failure is suspected, switch the patient to an alternative regimen as soon as possible
- The most common adverse reactions (incidence ≥2%, all grades) with Cabenuva were injection site reactions, pyrexia, fatigue, headache, musculoskeletal pain, nausea, sleep disorders, dizziness, and rash
- Refer to the applicable full Prescribing Information for important drug interactions with Cabenuva, VOCABRIA, or EDURANT
- Because Cabenuva is a complete regimen, coadministration with other antiretroviral medications for the treatment of HIV-1 infection is not recommended
- Drugs that are strong inducers of UGT1A1 or 1A9 are expected to decrease the plasma concentrations of cabotegravir. Drugs that induce or inhibit CYP3A may affect the plasma concentrations of rilpivirine
- Cabenuva should be used with caution in combination with drugs with a known risk of Torsade de Pointes
USE IN SPECIFIC POPULATIONS
- Pregnancy: There are insufficient human data on the use of Cabenuva during pregnancy to adequately assess a drug-associated risk for birth defects and miscarriage. Discuss the benefit-risk of using Cabenuva during pregnancy and conception and consider that cabotegravir and rilpivirine are detected in systemic circulation for up to 12 months or longer after discontinuing injections of Cabenuva. An Antiretroviral Pregnancy Registry has been established
- Lactation: The CDC recommends that HIV 1−infected mothers in the United States not breastfeed their infants to avoid risking postnatal transmission of HIV-1 infection. Breastfeeding is also not recommended due to the potential for developing viral resistance in HIV-positive infants, adverse reactions in a breastfed infant, and detectable cabotegravir and rilpivirine concentrations in systemic circulation for up to 12 months or longer after discontinuing injections of Cabenuva
Please see full Prescribing Information.
About ViiV Healthcare
ViiV Healthcare is a global specialist HIV company established in November 2009 by GSK (LSE: GSK) and Pfizer (NYSE: PFE) dedicated to delivering advances in treatment and care for people living with HIV and for people who are at risk of acquiring HIV. Shionogi became a ViiV shareholder in October 2012. The company’s aims are to take a deeper and broader interest in HIV and AIDS than any company has done before and take a new approach to deliver effective and innovative medicines for HIV treatment and prevention, as well as support communities affected by HIV.
For more information on the company, its management, portfolio, pipeline, and commitment, please visit www.viivhealthcare.com.
GSK is a global biopharma company with a purpose to unite science, technology, and talent to get ahead of disease together. Find out more at gsk.com/company
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GSK cautions investors that any forward-looking statements or projections made by GSK, including those made in this announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Such factors include, but are not limited to, those described in the Company's Annual Report on Form 20-F for 2021, GSK’s Q4 Results for 2022 and any impacts of the COVID-19 pandemic.
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