NHS Scotland approves long-acting cabotegravir and rilpivirine injections
31 October 2021. Related: Antiretrovirals.
Simon Collins, HIV i-Base
On 11 October 2021, the Scottish Medicines Agency (SMA) approved the first long-acting injectable HIV combination of cabotegravir (CAB-LA) and rilpirivine (RPV-LA) as a new treatment for HIV. 
The indication is as a switch option for people already on stable ART with undetectable viral load, without previous resistance or viral failure with combinations that include an NNRTI or integrase inhibitor.
Each injection is packaged separately and is given as an intramuscular injection every two months. Use first involves a four-week oral lead-in period and a higher dose initial injection.
Potential benefits compared to oral treatment linked to improved quality of life includes easier adherence although the indication for people to already have sustained viral suppression limits use by people who are currently less adherent and who might benefit most.
Other advantages include no longer needing to hide medicines, being easier for those with swallowing difficulties, or for people without stable housing, although more clinic visits will be needed.
The list price for the two-monthly doses of CAB-LA (Vocabria) and RPV-LA (Rekambys) is approximately £1200 and £440 respectively: just short of £10,000 for a year.
The lower negotiated price as part of a Patient Access Scheme (PAS) has not been released – but ICER/QALY models and base-case scenarios are referenced in the detailed SMA advice. 
The SMA document doesn’t include either national targets or caps on the number of people who could access this injectable combination, but numbers submitted by ViiV Healthcare estimate that 700 people might use this treatment in year one and 800 in year two.
For clinical details, please see full prescribing details for each drug. [3, 4]
This news is welcomed after a long development programme for this innovative new treatment.
CAB-LA plus RPV-LA were approved in the EU on 21 December 2020. 
STOP PRESS: Approval by NHS England was announced on 18 November 2021, to cover approximately 13,000 people.
- Scottish Medicines Consortium. Cabotegravir (Vocabria) is accepted for use within NHS Scotland. (11 October 2021).
- Scottish Medicines Consortium. Detailed advice.
- EMA. CAB-LA.
- EMA. RPV-LA.
- Long-acting injectable HIV treatment approved in the EU: includes two-monthly dosing. HTB (January 2020).
This report was first published on 14 October 2021.