The minority of those who switched to more expensive PrEP had clinical reasons

A recent study by researchers at the Harvard Pilgrim Health Care Institute found that a minority of patients who switched to a more expensive version of pre-exposure prophylaxis (PrEP) therapy had documented clinical reasons for doing so.

The results of the study were published in the journal Open Forum on Infectious Diseases.

“One of the most critical barriers to widespread and equitable use of PrEP in the United States has been cost, including perceived and actual costs,” said Julia Marcus, lead author of the study. “Generic TDF / FTC could revolutionize access to PrEP, but this opportunity will be missed if resources are invested in a much more expensive drug without commensurate improvements in clinical outcomes.”

There are currently 2 forms of PrEP therapy, tenofovir disoproxil fumarate and emtricitabine (TDF / FTC or Truvada) and the newer tenofovir alafenamide with emtricitabine (TAF / FTC or Descovy).

Both forms are safe and very effective, however, TAF / FTC costs significantly more per month.

For the study, the team of investigators analyzed data from the electronic health records of 2,892 adults who were assigned male at birth, were prescribed TDF / FTC for PrEP during the course of the study. year before FDA approval of TAF / FTC and had at least one prescription for PrEP in the following year.

They then assessed how many PrEP users switched to the more expensive version and whether they had any clinical indication for a change.

Study results showed that 11.9% of participants switched to TAF / FTC the first year it was available. However, investigators found that only 7% of participants who switched had clinical indications for doing so.

Additionally, when the indications for change also included risk factors for developing renal dysfunction, such as hypertension and diabetes, up to 27% of the changes were clinically indicated.

“Efforts to end the HIV epidemic can be threatened if more expensive drugs are used when comparable and cheaper options are available,” said Kenneth Mayer, co-author of the study. “Our study underscores the need to ensure that decisions about PrEP drugs are both clinically sound and cost effective. “

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