For virologically suppressed individuals 12 years or older weighing at least 35 kg with HIV-1. See Full Indication.
Safety
of Once-Monthly CABENUVA
The information below gives an overview of the potential risks and side effects of CABENUVA as observed in ATLAS and FLAIR, including drug-related adverse events, discontinuation rates due to adverse events, injection-site reactions (ISRs), and patient perception of injections.
Majority of adverse reactions were Grades 1-2
ISRs were the most common side effect associated with CABENUVA, the majority of which were mild to moderate.
POOLED ANALYSIS: ADVERSE REACTIONS* (ALL GRADES†) REPORTED IN ≥2% OF PATIENTS THROUGH WEEK 481
*Adverse reactions defined as “treatment-related” as assessed by the investigator. †Grade 1=mild; Grade 2=moderate; Grade 3=severe; Grade 4=potentially life-threatening; Grade 5=death.2 ‡Pyrexia: includes pyrexia, feeling hot, chills, influenza-like illness, body temperature increased. §Fatigue: includes fatigue, malaise, asthenia. ‖Musculoskeletal pain: includes musculoskeletal pain, musculoskeletal discomfort, back pain, myalgia, pain in extremity. ¶Sleep disorders: includes insomnia, poor quality sleep, somnolence. #Rash: includes erythema, pruritis, pruritis generalized, purpura, rash-erythematous, generalized, macular.
AE=adverse event.
- 4% of patients experienced Grade 3 ISRs, and no patients experienced Grades 4-5 ISRs
- Non-injection site-related adverse reactions leading to discontinuation and occurring in >1 patient were headache, diarrhea, hepatitis A, and acute hepatitis B (all with an incidence <1%)
Of patients discontinued CABENUVA due to adverse events
Of patients discontinued CABENUVA due to injection site reactions
FLAIR 96 Weeks: Safety Data
Adverse reactions were similar at Week 48 and Week 963
SAFETY OVERVIEW 3
**Or DTG plus 2 NRTIs if HLA-B*5701-positive. ††Includes 1 subject at Week-48 data analysis who is not present at Week-96 data analysis.3 ‡‡2 pyrexia, 2 fatigue, 2 dizziness, 1 headache/nausea, 1 pre-syncope, 1 depressed mood, 1 pyrexia/chills, 1 chronic sinusitis/chronic tonsillitis, 1 back pain and nasopharyngitis, 1 musculoskeletal pain, 1 anxiety, 1 influenza-like illness, 1 asthenia/depressed mood.3 §§1 diarrhea/abdominal pain/nasopharyngitis/eye pain, 1 insomnia, 1 abnormal dreams, 1 poor-quality sleep, 1 nausea, 1 hypercholesterolemia/vitamin D decreased.3 ‖‖Grade 3=severe; Grade 4=potentially life-threatening.2
AE=adverse event; ISR=injection site reaction; SAE=serious adverse reaction.
**Or DTG plus 2 NRTIs if HLA-B*5701-positive. ††Includes 1 subject at Week-48 data analysis who is not present at Week-96 data analysis.3 ‡‡Grade 3=severe; Grade 4=potentially life-threatening.2 §§2 pyrexia, 2 fatigue, 2 dizziness, 1 headache/nausea, 1 pre-syncope, 1 depressed mood, 1 pyrexia/chills, 1 chronic sinusitis/chronic tonsillitis, 1 back pain and nasopharyngitis, 1 musculoskeletal pain, 1 anxiety, 1 influenza-like illness, 1 asthenia/depressed mood.3 ‖‖1 diarrhea/abdominal pain/nasopharyngitis/eye pain, 1 insomnia, 1 abnormal dreams, 1 poor-quality sleep, 1 nausea, 1 hypercholesterolemia/vitamin D decreased.3
AE=adverse event; ISR=injection site reaction; SAE=serious adverse reaction.
No new safety signals identified through Week 96
INJECTION SITE REACTIONS
88% of patients experienced at least one ISR through Week 963
- The majority (3082/3100, 99%) of ISRs were Grades 1-2 and most (89%) resolved within ≤7 days (median duration of 3 days [interquartile range, 2 to 4])3
- Between Week 48 and Week 96, 1 patient withdrew due to an ISR3
- An additional 3 patients receiving CABENUVA withdrew from the study through Week 96; the primary reason for discontinuation given was "withdrew consent due to intolerability of injections"3
ADVERSE REACTIONS* (ALL GRADES, EXCLUDING LOCAL ISRs) REPORTED IN ≥3% OF PATIENTS IN EITHER ARM THROUGH WEEK 963
*Adverse reactions defined as “treatment-related” as assessed by the investigator. **Or DTG plus 2 NRTIs if HLA-B*5701-positive. ¶¶Between Weeks 48 and 96, discontinuations occurred due to: hepatitis A (3); acute hepatitis B (2); depression (2); and 1 each acute hepatitis C, hepatitis C, secondary syphilis, discomfort, diarrhea, vomiting, aminotransferase increased, and adenocarcinoma of colon; a participant could have more than one reason for withdrawal.
Patient-reported local injection site reactions decreased over time
Overall, 83% of patients experienced at least one ISR through Week 48.
Self-reported ISRs could potentially underestimate the true rate of ISRs over time. ISRs may still be present but not reported during the course of the study.
POOLED ANALYSIS (SECONDARY ENDPOINT): INCIDENCE OF ISRs REPORTED BY VISIT (ALL GRADES)1,4
My primary side effect is soreness on my right side for about two to three days. Over time, it has gotten less tender and sore.
– Jayson, clinical study participant. Compensated by ViiV Healthcare.
Patient experience is not indicative of all patient experiences or trial results.
The median duration of ISR events was 3 days (range: 1-341 days).1
- 88% of events lasted between 1-7 days
- 6% lasted 8-14 days
- 5% lasted >14 days4
Most common local injection site reaction was pain
Of patients experienced at least one ISR through Week 48
POOLED ANALYSIS: PATIENTS (>1%) REPORTING ISRs THROUGH WEEK 481
##591 patients were used to calculate the 77% reporting localized pain, as opposed to 581 patients used to calculate the 79% listed in the Prescribing Information for CABENUVA.1
- Abscess and cellulitis at the injection site were each reported in <1% of patients
3663 (25%) ISRs were reported after 14,682 injections
POOLED ANALYSIS: ISR EVENTS BY INJECTIONS GIVEN THROUGH WEEK 481,4
Other injection site reactions
Other injection-associated adverse reactions included an increased incidence of pyrexia (8%)***; reports of musculoskeletal pain (3%) and less frequently, sciatica; and vasovagal or pre-syncopal reactions (<1%).
***No cases were serious or led to withdrawal, and the occurrences of pyrexia may represent a response to administration of CABENUVA via intramuscular injection.
FLAIR 96 Weeks: ISRs
1% of patients discontinued due to ISRs through Week 96
Between Week 48 and Week 96, 1 additional patient discontinued CABENUVA due to ISRs3†††
In FLAIR, through Week 96:
- The majority (3082/3100, 99%) of ISRs were Grade 1-23
- Most (89%) ISR events resolved within ≤7 days (median duration of 3 days [interquartile range, 2 to 4])3
- Patient-reported local ISRs decreased from baseline to Week 961,3
- Self-reported ISRs could potentially underestimate the true rate of ISRs over time. ISRs may still be present but not reported during the course of the study
of patients experienced at least one ISR through Week 961
PATIENTS (≥5%) REPORTING ISRs THROUGH WEEK 961
3100 (25%) ISRs were reported after 12,552 injections1
ISR EVENTS (MOST FREQUENT) BY INJECTIONS GIVEN THROUGH WEEK 961,3
††† An additional 3 patients receiving CABENUVA withdrew from the study between Week 48 and Week 96; the primary reason for discontinuation given was “withdrew consent due to intolerability of injections.”3
87% of patients rated ISRs/pain as “totally acceptable” or “very acceptable” at Week 48
In ATLAS and FLAIR, patient perception of injections was evaluated as a secondary endpoint. Patients receiving CABENUVA were asked to respond to 21 questions included in the PIN questionnaire (scored on a scale of 1-5).1
The PIN questionnaire included 2 questions in the acceptance domain1:
- How acceptable was/were your local reaction(s)?
- How acceptable was your pain?
The score was calculated as the average of the 2 items within the domain. Higher scores represent a worse perception of the injection. Weeks 41 and 48 were compared to Week 5 based on the Wilcoxon signed-rank test. Average scores in Week 41 and 48 were each statistically significantly different from the average score in Week 5 (P<0.001 for each comparison).1
Clinical significance is unknown. These data collected directly from patients should not be used to infer clinical significance and should not be interpreted as a reflection of the efficacy or safety of a regimen.
POOLED ANALYSIS: ACCEPTANCE DOMAIN1
‡‡‡Percentages may total more than 100% due to rounding.
PIN=perception of injection.
References:
- Data on file, ViiV Healthcare.
- National Institute of Allergy and Infectious Diseases. DAIDS RSC Regulatory Support Center. DAIDS Adverse Event Grading Tables. Corrected version 1.2, July 2017. Accessed September 14, 2022. https://rsc.niaid.nih.gov/clinical-research-sites/daids-adverse-event-grading-tables.
- Orkin C, Oka S, Philibert P, et al. Long-acting cabotegravir plus rilpivirine for treatment in adults with HIV-1 infection: 96-week results of the randomised, open-label, phase 3 FLAIR study. Lancet HIV. 2021;8:e185–96.
- Rizzardini G, Overton ET, Orkin C, et al. Long-acting injectable cabotegravir + rilpivirine for HIV maintenance therapy: week 48 pooled analysis of phase 3 ATLAS and FLAIR trials. J Acquir Immune Defic Syndr. 2020;85(4):498-506.
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