Cabenuva

[120DaysofSodom]

Is anybody receiving this and was formerly on Biktarvy?

I just returned from Prague and when I met with my specialist for routine blood work and full panel exam, I talked with him about this new medication I had heard about from my friend that was just approved for use in January 2021. It is called Cabenuva and it is a monthly injection in your bum. My doctor told me that I was the right candidate for it (a patient that has been undetectable for years and hasnt had any side effects from their current medication and adheres to their medication regime). I would be the fourth patient at the health system to begin receiving it. Theyre going to start me on the medication in the next couple of weeks in pill form to ensure I dont have any allergic reaction to it and that I can tolerate it well, and then the month after that if all goes well, theyll begin giving me the injections. Its a different class of drug than Biktarvy, which is what I currently take, and is about twice as much as the cost of Biktarvy. Just wanted to share this info with you guys because it seems pretty revolutionary to receive an injection once a month rather than having to take a pill once a day. He also said that the pharmaceutical company that developed it is researching whether or not the injection can be administered once every two months as opposed to once a month, but its still early days.

[fskn]

Earlier this month, the FDA expanded the approval of Cabenuva, cabotegravir and rilpivirine injections for HIV treatment, to allow injections every 2 months rather than every 1 month, for virally-suppressed patients without resistance concerns and without past treatment failure.

I just got off a public health call in San Francisco, where this novel treatment has been in use for months, in a fairly large group of patients. One patient told us that it had improved his health and changed his life, and another, whose doctor relayed his experience, was happy that he could schedule a trip to his home country between injections without risking scrutiny of his HIV pills at the border.

Insurance coverage has not been a problem, nor has drug stock, but both are expected to be concerns in other states.

Doctors expected that their patients, who are accustomed to coming in every 3 or 6 months, would not be interested in coming in every month for an injection, but instead, the response has been enthusiastic. The particular medical facility has not switched anyone to a 2-month schedule yet.

Oral bridge — taking cabotegravir and rilpivirine pills if someone misses an injection — is possible but was flagged by one doctor as impractical. (One concern is that the pills have to be taken with a meal.) Instead, this facility recommends that patients keep a 1-month supply of whatever HIV pill(s) they previously used.

@120DaysofSodom and others, if you are comfortable sharing, did you start the injectable, and what has it been like for you so far?

(In a separate thread, I mentioned the recent approval of Apretude, the cabotegravir injection for PrEP. Apretude is fundamentally a 2-month injection.)

[120DaysofSodom]

2 minutes ago, fskn said:

Earlier this month, the FDA expanded the approval of Cabenuva, cabotegravir and rilpivirine injections for HIV treatment, to allow injections every 2 months rather than every 1 month, for virally-suppressed patients without resistance concerns and without past treatment failure.

I just got off a public health call in San Francisco, where this novel treatment has been in use for months, in a fairly large group of patients. One patient told us that it had improved his health and changed his life, and another, whose doctor relayed his experience, was happy that he could schedule a trip to his home country between injections without risking scrutiny of his HIV pills at the border.

Insurance coverage has not been a problem, nor has drug stock, but both are expected to be concerns in other states.

Doctors expected that their patients, who are accustomed to coming in every 3 or 6 months, would not be interested in coming in every month for an injection, but instead, the response has been enthusiastic. The particular medical facility has not switched anyone to a 2-month schedule yet.

Oral bridge — taking cabotegravir and rilpivirine pills if someone misses an injection — is possible but was flagged by one doctor as impractical. (One concern is that the pills have to be taken with a meal.) Instead, this facility recommends that patients keep a 1-month supply of whatever HIV pill(s) they previously used.

@120DaysofSodom and others, if you are comfortable sharing, did you start the injectable, and what has it been like for you so far?

(In a separate thread, I mentioned the recent approval of Apretude, the cabotegravir injection for PrEP. Apretude is fundamentally a 2-month injection.)

Oh really? I will ask my specialist about that next week when I go in for my injection. Theyve been telling me that its been in the approval process to be administered every 2 months but they didnt mention anything about it at the beginning of the month when I got my last shot. It would be great because getting the shot hurts like hell for a day or two afterwards.

When they started me on the medication, the first month was by pills so that they could make sure my body would tolerate it. I had to take it with a meal because the medication requires at minimum 500 calories when taken to absorb into your body. I didnt really understand that when she explained it to me and thought it was more to avoid nausea. So a few times I just took it with something like a yogurt and when came the time to give me injections, my viral load went up slightly  (to 70, so it remained undetectable) which may have had something to do with not taking every dose with a 500 calorie meal, or may just have been from switching from Biktarvy to the Cabotegravir and rilpivirine. Im about to receive my 6th shot (I think it is), and the pain from the shot has become more tolerable each time I get it. The first shot will hurt like hell for about a week because its a loading dose. Last shot hurt for only about 2 days. Its certainly much more convenient because you dont have to worry about remembering if you took your pill or not every day.

[loadzgoinholes]

@120DaysofSodom - what was wrong with the Biktarvy? It seems to work great for me.

[120DaysofSodom]

18 minutes ago, loadzgoinholes said:

@120DaysofSodom - what was wrong with the Biktarvy? It seems to work great for me.

Nothing was wrong with it. It was great and worked just fine. But I was told about Cabenuva while I was in Slovakia and it has been in use in Europe since before it was approved for use in the States. When I got back to the U.S., I asked my doctor about it and he said it was approved for use just a few months prior, and that id be one of the first few patients hed put on it. I prefer the shots because its just a lot less intrusive on life to not have to take a pill every single day.

[120DaysofSodom]

On 2/24/2022 at 10:12 PM, fskn said:

Earlier this month, the FDA expanded the approval of Cabenuva, cabotegravir and rilpivirine injections for HIV treatment, to allow injections every 2 months rather than every 1 month, for virally-suppressed patients without resistance concerns and without past treatment failure.

 

Just had an appointment 2 days ago for my monthly injection and my doctor told me about the 2 month approval by the FDA and that I was a good candidate for that. They would have started me next month on the bimonthly injections but the date of the appointment would have been the day before I attend a music festival so I pushed the bimonthly injection off to May and next month ill just receive the single month injection. The difference between the two apparently is that the bimonthly injection is pretty much the equivalent of the "loading dose injection" that they give you the first time you switch to Cabenuva injections, and that one hurt like fucking hell. Felt like I had been shot in the ass lol and I was off my feet for a couple days because it was just too painful. I havent experienced much pain anymore with the single month injections the last few times ive received them, so I think your body habituates to the sensitivity of receiving them in the same place on a routine basis.

[fskn]

This is excellent news, @120DaysofSodom! Good luck, and please let people know how it turns out when you do switch to the two-month schedule.

[EricX]

I’m curious as to why someone would switch to this if they are doing well on their current pill regimen, especially if it is more expensive? The only instance I can see this solving a problem is for patients with compliance issues. Otherwise it seems more difficult to go to the doctor every two months rather than to just pop a daily pill. 

[funpozbottom]

1 hour ago, EricX said:

I’m curious as to why someone would switch to this if they are doing well on their current pill regimen, especially if it is more expensive? The only instance I can see this solving a problem is for patients with compliance issues. Otherwise it seems more difficult to go to the doctor every two months rather than to just pop a daily pill. 

There are a few reasons why I would consider switching if I had the opportunity. The first is that I don't like pills. I've always had trouble swallowing pills but I've never had any anxiety about getting shots. Given the choice between 1 shot or 60 pills, I'll take the shot.

The next reason is potentially fewer side effects.  One of the biggest reasons people switch meds is because the older classes of drugs are damaging to the body. Getting a single dose of a medication every two months, in theory, will be less damaging than the continual exposure one gets from a daily pill. This becomes more of an issue the older you are, and the longer you are on meds. I'm over 60 and have been on meds for 9 years. Biktarvy works fine for me and my labs are good, but being able to reduce the amount of drugs going into my body is something to consider.

Third reason is it frees my schedule a little. I like to travel. If I don't need to be home to pick-up a prescription every month, or worry about whether I'll have enough of my meds to last until I get home, it makes scheduling trips a little more flexible.

Last is cost. Yes, its more expensive if given on a monthly basis, but if the shot is every 2 months, then the cost averages out the same. The thing is, they are studying whether this and some other meds are effective with an even longer interval.  If it can be extended for 4 months, then the cost becomes half of other medications, and can be incorporated into regular office visits. But that will take longer to happen unless people switch to provide more real world data on safety and effectiveness.

[fskn]

3 hours ago, EricX said:

I’m curious as to why someone would switch to this if they are doing well on their current pill regimen, especially if it is more expensive? The only instance I can see this solving a problem is for patients with compliance issues. Otherwise it seems more difficult to go to the doctor every two months rather than to just pop a daily pill. 

I've already mentioned a few reasons above.

Some people prefer not having to keep, carry, or travel with pills that identify them as HIV-positive. Remember that many countries, including the US, denied entry to HIV-positive non-citizens; some still hassle people found to be carrying HIV medications.

Some people prefer having a regular monthly (and now, bimonthly) injection to having to remember to take one or more pills every day. There is a potential for higher adherence in general.

Don't assume that the out-of-pocket cost of injectables will be higher. In the US, Affordable Care Act regulations, state regulations, and the drug manufacturer's patient assistance programs, mean that this will generally not be the case. Also, it will never be the case when a medical professional prescribes an injectable because a patient has demonstrated poor adherence to a daily pill regimen.

We are lucky to have a wide variety of HIV treatment (and also prevention — Apretude, a 2-month, cabotegravir-only injectable is now approved for PrEP in the US) options.

We know from work done in the field of birth control that giving patients more choices means higher uptake and greater success. Choice is a big motivator for patients!

In this case, participants in clinical trials of cabotegravir + rilpivirine injections (Cabenuva) for HIV treatment generally preferred the injectable, despite soreness at the injection site, which was a common side effect.

A 1- or 2-month visit interval is short for HIV patients, who would normally come in for tests every 6 months or every 3 months, in the US. That said, Cabenuva is the first step, not the last. In time, we are likely to see other HIV drugs offered in injectable form, with longer intervals between injections, possibly smaller liquid volumes and/or other injection sites, which might even make patient self-injection possible someday.

(For prevention, coming in for an Apretude injection every 2 months is not  a big change from coming in for tests every 3 months, per US CDC PrEP guidelines.)

Edited March 6, 2022 by fskn

[BootmanLA]

7 hours ago, fskn said:

Also, it will never be the case when a medical professional prescribes an injectable because a patient has demonstrated poor adherence to a daily pill regimen.

This is the one part of your (otherwise spot-on) post that I'm not so sure about. There are populations that might well benefit in that circumstance - for instance, a homeless person who has a pretty fixed abode, who wants to stay healthy but has issues with remembering to take pills, or who doesn't want to carry them on him because of fears of losing them and/or having them stolen. It's been discussed that in such cases, someone with a social services outreach team could make a point of treating those patients in the field, so to speak, either by having a regular day when people can show up, or by visiting certain encampments or whatever on a regular basis.

That won't be everyone, of course - it's something that would work best with patients who don't have severe mental illnesses that can make them uncooperative.

And of course, when you get to older people (as we're getting to folks with HIV hitting their 70's and 80's), some patients won't remember to take all their medications and don't have anyone checking on them to remind them. Having a social services medical worker come by every couple of months with a shot might be just what some people need. Again, that won't be everyone, of course, but I think there definitely will be cases where inability to adhere to a daily pill regimen will strongly suggest the injectable route.

[120DaysofSodom]

On 3/6/2022 at 12:25 PM, EricX said:

I’m curious as to why someone would switch to this if they are doing well on their current pill regimen, especially if it is more expensive? The only instance I can see this solving a problem is for patients with compliance issues. Otherwise it seems more difficult to go to the doctor every two months rather than to just pop a daily pill. 

Because it is way more convenient to get a shot once a month, or once bi-monthly, and then never have to worry about taking pills every day of your life. The difference is as clear as night and day: 12 (or 6) doses of medication per year versus 365 doses of medication. Management of pills, even when youre responsible with taking them, is a bitch. I made the decision when I was in Prague, Czech Republic last year to try and get these Cabenuva shots because I came back one day and had literally forgotten whether or not I had taken my pill, as I didnt have my M-Sunday pill dispenser with me and just dosed out my meds in a bottle for the duration of the trip (also, what if you lost those pills while you were on your trip? Theres another good reason to take the shots).