One week of rifampicin cut long-acting rilpivirine levels by 83%, below target

The edition in brief

A Dutch case report measured plasma levels in a man on long-acting cabotegravir and rilpivirine every eight weeks who needed seven days of rifampicin. With oral dolutegravir-based bridging in place, cabotegravir fell 57% and rilpivirine 83%, below its target trough, then recovered within a week of stopping rifampicin as the depot continued to release drug; viral load stayed undetectable. The fall in rilpivirine exceeded model predictions. A UK tertiary clinic series of 88 patients on dialysis found no major bleeds with apixaban 2.5 mg twice daily against 7.3% with vitamin K antagonists, with more strokes on apixaban (7.1 vs 1.1 per 100 patient-years); neither difference was significant, and nearly all apixaban anti-Xa troughs were within the general population range. FDA's database records supplemental approvals for abrocitinib on 2 September and toripalimab on 31 August; the records do not state what changed. A commentary argues that adverse drug reaction forms should capture withdrawal reactions, to support safer deprescribing.