A combination of two long-acting injectable anti-HIV drugs taken once monthly had a very low rate of treatment failure and a favourable safety profile, according to results from two phase III trials presented yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle.

Dual injections of cabotegravir, an experimental integrase inhibitor, and the non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine, currently available as a pill (Edurant), maintained viral suppression among treatment-experienced people switching from a standard oral regimen and among previously untreated people after a short three-drug induction period.

What's more, study participants expressed a high level of satisfaction with monthly injections compared with daily pills, and nearly all said they would prefer to use the injectable method, reported Dr Susan Swindells of the University of Nebraska Medical Center and Dr Chloe Orkin of Queen Mary University of London.

The phase II LATTE trials previously demonstrated that a simplified oral regimen of cabotegravir plus rilpivirine is effective as maintenance therapy. This supported the evaluation of injectable formulations of the two drugs in previously untreated patients. As reported at the 2016 International AIDS Conference, 91% of people who received the injections every 4 weeks and 92% of those who did so every 8 weeks had undetectable viral load at week 48.

This set the stage for larger phase III trials. ATLAS (Antiretroviral Therapy as Long-Acting Suppression) evaluated injectable cabotegravir plus rilpivirine in people who switched from a standard oral antiretroviral combination with an undetectable viral load, while FLAIR (First Long-Acting Injectable Regimen) tested the injectables in people starting HIV treatment for the first time. Read more via AIDSmap

Swindells S et al. Long-acting cabotegravir + rilpivirine as maintenance therapy: ATLAS week 48 results. Conference on Retroviruses and Opportunistic Infections, Boston, abstract 139 LB, 2019.

View the abstract on the conference website.

Watch the webcast of this session on the conference website.

Orkin C et al. Long-acting cabotegravir + rilpivirine for HIV maintenance: FLAIR week 48 results. Conference on Retroviruses and Opportunistic Infections, Boston, abstract 140 LB, 2019.

View the abstract on the conference website.

Watch the webcast of this session on the conference website.