Cabotegravir Plus Rilpivirine Injection for Virally Suppressed Persons with HIV-1 infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Purpose: This study evaluated the efficacy and safety of cabotegravir/rilpivirine long-acting formulation compared to oral standard of care at 48 and 52 weeks.

Method: We conducted an electronic search (2005-2024) across databases for articles comparing the safety and efficacy of long-acting cabotegravir/rilpivirine with oral triple ART regimens. We analyzed efficacy and safety (treatment discontinuation and adverse effects). We used proportions of participants maintaining viral suppression, experiencing adverse drug effects or discontinuing treatment due to trial regimen, risk ratios, and 95% confidence intervals for pooled estimates.

Findings: Five RCTs with 2215 participants were analyzed, with 1390 receiving cabotegravir/rilpivirine injections. The analysis found long-acting cabotegravir/rilpivirine as effective as oral ART for viral load suppression (RR [P = 0.23, 0.99 95% CI; 0.97-1.01], I² = 0%) up to 52 weeks. However, more adverse effects were reported with the oral treatment [RR 1.32 (95% CI; 1.12-1.54), I² = 56%]. Pooled reports showed a significant an increased risk of treatment withdrawal in the oral group, [RR 3.61 (95% CI; 0.87-14.98), I² = 53 IMPLICATION: Findings from this meta-analysis emphasised the efficacy and safety of Cabotegravir/rilpivirine long-acting formulation in providing long-term maintenance of viral load suppression in HIV-1 infection with a tolerable safety profile.

Keywords: Cabotegravir/rilpivirine; HIV-1; adverse events; treat-related withdrawal; viral suppression.