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

• Main Authors: Chow W, Donga P, Côté-Sergent A, Rossi C, Lefebvre P, Lafeuille MH, Hardy H, Emond B
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-11-01
• Series: Patient Preference and Adherence
• Subjects: hiv; protease inhibitors; treatment adherence and compliance; patient compliance; administrative claims; healthcare; electronic health records
• Online Access: https://www.dovepress.com/treatment-patterns-and-predictors-of-adherence-in-hiv-patients-receivi-peer-reviewed-article-PPA

Wing Chow,1 Prina Donga,1 Aurélie Côté-Sergent,2 Carmine Rossi,2 Patrick Lefebvre,2 Marie-Hélène Lafeuille,2 Hélène Hardy,2 Bruno Emond3 1Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA; 2Analysis Group, Inc., Montréal, QC, Canada; 3Early Compound Development, Janssen Research & Development, LLC, Titusville, NJ, USACorrespondence: Bruno Emond Tel [phone]Email [e-mail]: Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide can be used as a single-tablet regimen (STR, DRV/c/FTC/TAF) or multiple-tablet regimen (MTR, DRV/c+FTC/TAF) to treat patients with human immunodeficiency virus (HIV). This study described treatment patterns and predictors of adherence among patients with HIV initiated on DRV/c/FTC/TAF or DRV/c+FTC/TAF.Patients and Methods: A retrospective longitudinal study was conducted using linked claims and electronic medical records from Decision Resources Group’s Real World Data Repository (7/17/2017– 6/1/2019). Treatment-naïve and treatment-experienced virologically suppressed adults with HIV-1 prescribed DRV/c/FTC/TAF or DRV/c+FTC/TAF (index date) were included. Six-month persistence (no treatment gaps > 60 and > 90 days) and adherence (proportion of days covered [PDC]) to the index regimen were evaluated among patients with ≥ 6 months of observation post-index. Predictors of low adherence (PDC< 80%) were evaluated using a logistic regression model.Results: Among 2633 eligible patients (49.5 years old, 29% female, 37% African American/Black), 12% were treatment-naïve pre-index and 88% switched from a previous antiretroviral therapy; 84% initiated DRV/c/FTC/TAF and 16% initiated DRV/c+FTC/TAF. Among 822 DRV/c/FTC/TAF patients with ≥ 6 months of observation post-index, 80% and 86% had no > 60- and > 90-day gaps in DRV/c/FTC/TAF coverage, respectively, while among 204 DRV/c+FTC/TAF patients with ≥ 6 months of observation post-index, 69% and 75% had no > 60- and > 90-day gaps in DRV/c+FTC/TAF coverage, respectively. Mean (median) PDC for the index regimen was 81% (93%) for patients treated with DRV/c/FTC/TAF and 73% (83%) for patients treated with DRV/c+FTC/TAF. Predictors of low adherence included younger age (odds ratio [OR]=2.36, p=0.017), higher Quan-Charlson comorbidity index (OR=1.32, p=0.012), use of MTR regimen at index (OR=1.69, p=0.022), and prior low adherence (OR=2.56, p< 0.001).Conclusion: Among patients initiating a DRV/c-based regimen, those initiating STR had higher 6-month adherence/persistence than those initiating MTR, highlighting the potential benefits of the STR formulation, particularly among younger patients with multiple comorbidities and prior low adherence.Keywords: HIV, protease inhibitors, treatment adherence and compliance, patient compliance, administrative claims, healthcare, electronic health records