Real-world adherence and persistence for newly-prescribed HIV treatment: single versus multiple tablet regimen comparison among US medicaid beneficiaries

Abstract

Background: Once-daily, single-tablet regimens (STRs) have been associated with improved patient outcomes compared to multi-tablet regimens (MTRs). This study evaluated real world adherence and persistence of HIV antiretroviral therapy (ART), comparing STRs and MTRs.Methods: Adult Medicaid beneficiaries (aged ≥ 18 years) initiating ART with ≥ 2 ART claims during the identification period (January 1, 2015-December 31, 2016) and continuous health plan enrollment for a 12-month baseline period were included. For STRs, the first ART claim date was defined as the index date; for MTRs, the prescription fill claim date for the last drug in the regimen was defined as the index date, and prescription fills were required to occur within a 5-day window. Adherence was assessed in 30-day intervals over a 6-month period, with adherence defined as having less than a 5-day gap between fills. Persistence was evaluated as median number of days on therapy and percent persistence at 12 months. Cox Proportional Hazard models were used to evaluate risk of discontinuation, controlling for baseline and clinical characteristics. Results:A total of 1,744 (STR = 1290; MTR = 454) and 2409 (STR = 1782; MTR = 627) patients newly prescribed ART had available data concerning adherence and persistence, respectively. Average age ranged 40-42 years. The patient population was predominantly male. Adherence assessments showed 22.7% of STR initiators were adherent to their index regimens over a 6-month period compared to 11.7% of MTR initiators. Unadjusted persistence analysis showed 36.3% of STR initiators discontinued first-line therapy compared to 48.8% for MTR initiators over the 2-year study period. Controlling for baseline demographic and clinical characteristics, MTR initiators had a higher risk of treatment discontinuation (hazard ratio [HR] =

<p>Treatment Patterns and Predictors of Adherence in HIV Patients Receiving Single- or Multiple-Tablet Darunavir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide</p>

“… 25 , 28–30 Regardless of the drug formulation, persistence rates remained high 6 months after the index date, corroborating adherence results for treatment-naïve patients rapidly initiated on DRV/c/FTC/TAF in the DIAMOND study, where mean (median) adherence as measured by pill count was 95% (99%) over a 48-week study period. 34 Post-index, a higher proportion of patients achieved PDC≥95% or PDC≥90% with DRV/c/FTC/TAF than with DRV/c+FTC/TAF, consistent with previous literature showing that adherence is higher with STRs than MTRs, 5 , 19–27 , 30 , 35 even when the components of the regimens are the same, as is the case in the current study (2-pill MTR versus STR). Additionally, >50% of patients achieved PDC to any ART ≥95%, higher than the 14–20% who achieved this threshold in a previous study.…”

“…The majority of patients used DRV/c/FTC/TAF and had previously received Patients using STR had higher persistence and adherence to the index regimen than those using MTR, consistent with prior studies. 25,[28][29][30] Regardless of the drug formulation, persistence rates remained high 6 months after the index date, corroborating adherence results for treatment-naïve patients rapidly initiated on DRV/c/FTC/ TAF in the DIAMOND study, where mean (median) adherence as measured by pill count was 95% (99%) over a 48-week study period. 34 Post-index, a higher proportion of patients achieved PDC≥95% or PDC≥90% with DRV/c/FTC/TAF than with DRV/c+FTC/TAF, consistent with previous literature showing that adherence is higher with STRs than MTRs, 5,[19][20][21][22][23][24][25][26][27]30,35 even when the components of the regimens are the same, as is the case in the current study (2-pill MTR versus STR).…”

“…On 7/17/ 2018, DRV/c/FTC/TAF (Symtuza ® ) became the first PIbased STR approved for HIV-1 treatment among treatmentnaïve patients and virologically suppressed adults stable on ART for ≥6 months. 14 While factors such as race, gender, and social determinants of health play an important role in adherence to ART, [15][16][17][18] studies show that STRs confer benefits with regards to adherence 5,[19][20][21][22][23][24][25][26][27] and persistence 25,[28][29][30] compared to MTRs. However, whether DRV/c/FTC/TAF STR improves adherence and persistence compared to the 2-pill MTR formulation with the same components (ie DRV/c+FTC/TAF) remains to be assessed in a realworld setting.…”

Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States

“…The US Department of Health and Human Services (DHHS) guidelines for adults and adolescents living with HIV recommend multiple strategies to improve adherence to ART treatments, including providing uninterrupted access to care, motivation for ART initiation, the periodic assessment of adherence to ART and care, patient education on the importance of adherence, and the simplification of ART dosing, such as using a single-table regimen (STR) [ 9 , 10 ]. The use of STRs has been found in several studies to be associated with improved adherence to ART regimens versus multiple tablet regimens (MTRs) among PWH [ 7 , 11 – 15 ] and in some studies was also found to be associated with improved outcomes, including higher levels of viral suppression, decreased hospitalizations, and lower medical costs [ 7 , 11 , 14 ].…”

Long‐Term Administration of Abacavir and Etravirine Impairs Semen Quality and Alters Redox System and Bone Metabolism in Growing Male Wistar Rats

“…Antiretroviral therapy made it possible to decrease the viral load below the sensitivity limit of diagnostic tests, caused an increase in the level of CD4 lymphocytes, and reduced the incidence of opportunistic infections and the development of full-blown acquired immunodeficiency syndrome (AIDS). As a consequence, mortality in HIV patients has decreased significantly [2][3][4]. However, drug-induced side effects associated with longterm antiretroviral therapy are becoming a growing concern [2,3,5].…”