When will long-acting injections be available in the UK?
21 June 2021. Related: Access to treatment, All topics, Research.
Hi, do you know when injectable monthly medications and implants will become available in the UK? A doctor at a workshop I attended in November 2017 suggested it could be 2018.
Is this realistic?
Update (June 2021)
On 21 December 2021, the EU approved long-acting cabotegravir and rilpivirine injections.
Access in England will be decided by NICE in October 2021. The UK-CAB is coordinating community input to the meeting. Access will take up to three months from this meeting.
Update (September 2020)
On 29 July 2020, cabotegravir/rilpivirine injections (called Cabenuva) were resubmitted to the US FDA. This should mean a decision on US approval will be within the next 6-12 months.
Submission for EU approval was made a year ago so this decision is expected soon.
It will take another 9-12 months for the NHS to decide about access in the UK.
Update (July 2019)
The main results from both the ATLAS and FLAIR studies were presented at CROI 2019. Submission to FDA was made in July 2019 with a decision expected by the end of December 2019. The application to the EMA in Europe will follow shortly with a decision expected in early-mid 2020.
Phase 3 results with dual therapy cabotegravir/rilpivirine long-acting injections: ATLAS and FLAIR studies.
Named-patient/expanded access programmes are also now available for both long-acting formulation.
Thanks for your question as this is something lots of people are interested in. A friend even asked me this yesterday.
Unfortunately, 2018 sounds optimistic, unless you are already taking part in a research study. Regular approval on the NHS will probably not be until 2019 or more likely 2020.
Sometimes the timeline for drug development is difficult to predict. Research often takes longer than expected. As well as the early research this involves large phase 3 studies that usually need at least a year of results. Then the regulatory agency (ie the FDA in the US or EMA in Europe) takes 6 to 9 months to decide if the drug is safe and effective. In the UK, the NHS then takes another 6 to 12 months (at least) to decide if it will pay for the drug.
Currently, the phase 3 studies for long-acting cabotegravir plus rilpivirine are still ongoing. According to listed information online, the ATLAS and FLAIR studies are now fully enrolled. The first results are expected in June and September 2018, respectively. The company then needs several few months to compile the results. This means, if good, the regulatory agencies are unlikely to start evaluating long-acting injections until late 2018/early 2019. If approved later in 2019, the NHS will take at least until 2020 to decide if they will pay for access.
Links to each of these phase 3 studies is below:
- ATLAS (Antiretroviral Therapy as Long-Acting Suppression)
- FLAIR (First Long-Acting Injectable Regimen) study
This answer was updated in June 2021, September 2020 and April 2019 from an original Q&A posted in January 2018.
Please see the previous comment to Anonymous.
Here’s the link to the Treatment Action Campaign.
Just curious . Is the injection available in South Africa and how much is it?
As Simon says above, the long-acting injectables have been or will shortly be submitted for approval in the US and Europe.
But you could contact the Treatment Action Campaign to ask about availability in South Africa.
Hello . I would like to ask if the long-acting HIV drugs are available in SOUTH AFRICA?.
As of yet the injectable ARV isn’t available, It is still in the development stages.
Is the injectable ARV available in South Africa.. And if privately so at pharmacies.. And what are the costs?
Hi Sam, it is good to ask your doctor about whether your hospital is a site for these studies. Both the ATLAS and FLAIR studies are international, and the links in the main answer above includes a list of countries and hospitals that are sites. Unfortunately, Uganda isn’t listed but there might be other studies I do not know about.
I was reading in Uganda there is an approved injection trial underway ? Do you have any updates or additional information . Is this permanent or just another trial ?
The hope is that it will be priced as comparable to current combinations.
Most companies only decide the price after a drug is approved. This then varies between different countries and even within the same country. So in the UK, a company has to submit a tender for each of the seven main health regions and access can sometimes be different.
In the UK, all companies now realise that if they premium price (is charge more for a new drug) that their new drug would not be used. So in recent years, new HIV drugs have been priced roughly similar to existing drugs. In some cases, this even allows for the lower prices of generic drugs that might be used in the combination.
Most new drugs will always be available for some people, but the lower the price, the easier it will be to make them widely available as a choice for everyone. This would be a much better strategy for the company as there are a lot of people who are interested in an alternative to daily pills.
These injections are being developed by ViiV Healthcare who recently priced the dolutegravir fixed dose combination Triumeq to allow for the fact that the other two drug in the pill are now available as cheaper generics. That is an indication that access might be possible.
Does any medical professional know if injecting treatments will be cheaper than pills for the NHS ?
Obviously if more expensive …NHS will not approve it .