Renal considerations

The FTC/TAF backbone when used as a component of a single-tablet regimen* or in combination with other third agents in a multi-tablet regimen demonstrated less impact on selected renal laboratory parameters vs FTC/TDF-based regimens in virologically suppressed adults switching therapy1-3†‡

Study 109: UPCR declined in an FTC/TAF-based regimen* vs an FTC/TDF-based regimen; mean serum creatinine remained similar at Week 481,2

  • In Study 109, adults who switched to the FTC/TAF-based regimen* experienced a 21% decrease in mean UPCR vs a 10% increase in those who remained on the FTC/TDF-based regimen1,2*

There were 0 cases of proximal renal tubulopathy or Fanconi syndrome observed in adults who received an FTC/TAF-based regimen through Week 482


Warnings and precautions (cont'd)

  • New onset or worsening renal impairment: Cases of acute renal failure and Fanconi syndrome have been reported with the use of tenofovir prodrugs. In clinical trials of emtricitabine and tenofovir alafenamide with elvitegravir and cobicistat, there have been no cases of Fanconi syndrome or proximal renal tubulopathy (PRT). Do not initiate DESCOVY in patients with estimated creatinine clearance (CrCl) <30 mL/min. Patients with impaired renal function and/or taking nephrotoxic agents (including NSAIDs) are at increased risk of renal-related adverse reactions. Discontinue DESCOVY in patients who develop clinically significant decreases in renal function or evidence of Fanconi syndrome.
    Renal monitoring: In all patients, monitor CrCl, urine glucose, and urine protein prior to initiating and during therapy. In patients with chronic kidney disease, additionally monitor serum phosphorus.

Study 1089: Significantly less impact on eGFR at Week 483

  • The long-term clinical significance of these changes in eGFR is not known

Additional selected renal parameters at Week 483

  • The mean change from baseline in serum creatinine concentration in adults who switched to the FTC/TAF backbone was -0.08 mg/dL vs -0.04 mg/dL in adults who remained on the FTC/TDF backbone
  • For adults with a UPCR ≥200 mg/g, 75% (21/28) of those who switched to the FTC/TAF backbone vs 29% (7/24) who remained on the FTC/TDF backbone demonstrated an improvement in proteinuria, defined as a decrease in UPCR from ≥200 mg/g to <200 mg/g

See the Study 1089 Study Design

Important Safety Information

BOXED WARNING: LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH STEATOSIS and POST TREATMENT ACUTE EXACERBATION OF HEPATITIS B

  • Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs in combination with other antiretrovirals.
  • DESCOVY is not approved for the treatment of chronic hepatitis B virus (HBV) infection and the safety and efficacy of DESCOVY have not been established in patients coinfected with HIV-1 and HBV. Severe acute exacerbations of hepatitis B have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued products containing emtricitabine and/or tenofovir disoproxil fumarate (TDF), and may occur with discontinuation of DESCOVY. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who are coinfected with HIV-1 and HBV and discontinue DESCOVY. If appropriate, initiation of anti-hepatitis B therapy may be warranted.

Warnings and precautions

  • Fat redistribution or accumulation has been observed in patients receiving antiretroviral therapy.
  • Immune reconstitution syndrome, including the occurrence of autoimmune disorders with variable time to onset, has been reported.
  • New onset or worsening renal impairment: Cases of acute renal failure and Fanconi syndrome have been reported with the use of tenofovir prodrugs. In clinical trials of emtricitabine and tenofovir alafenamide with elvitegravir and cobicistat, there have been no cases of Fanconi syndrome or proximal renal tubulopathy (PRT). Do not initiate DESCOVY in patients with estimated creatinine clearance (CrCl) <30 mL/min. Patients with impaired renal function and/or taking nephrotoxic agents (including NSAIDs) are at increased risk of renal-related adverse reactions. Discontinue DESCOVY in patients who develop clinically significant decreases in renal function or evidence of Fanconi syndrome.
    Renal monitoring: In all patients, monitor CrCl, urine glucose, and urine protein prior to initiating and during therapy. In patients with chronic kidney disease, additionally monitor serum phosphorus.
  • Bone loss and mineralization defects: Decreases in bone mineral density (BMD) have been reported with the use of tenofovir prodrugs. Consider monitoring BMD in patients with a history of pathologic fracture or risk factors for bone loss. Mineralization defects, including osteomalacia associated with PRT, have been reported with the use of TDF-containing products.

Adverse reactions

  • Most common adverse reaction (incidence ≥10%; all grades) in clinical studies was nausea (10%).

Drug interactions

  • Prescribing information: Consult the full prescribing information for DESCOVY for more information on potentially significant drug interactions, including clinical comments.
  • Metabolism: Drugs that inhibit P-gp can increase the concentrations of components of DESCOVY. Drugs that induce P-gp can decrease the concentrations of components of DESCOVY, which may lead to loss of efficacy and development of resistance.
  • Drugs affecting renal function: Coadministration of DESCOVY with drugs that reduce renal function or compete for active tubular secretion may increase concentrations of emtricitabine and tenofovir and the risk of adverse reactions.

Dosage and administration

  • Dosage: Patients 12 years and older (≥35 kg): 1 tablet taken orally once daily with or without food.
  • Renal impairment: Not recommended in patients with CrCl <30 mL/min.
  • Testing prior to initiation: Test patients for HBV infection and assess CrCl, urine glucose and urine protein.

Pregnancy and lactation

  • Pregnancy: There are insufficient data on the use of DESCOVY during pregnancy. In animal studies, no adverse developmental effects were observed with the components of DESCOVY. An Antiretroviral Pregnancy Registry has been established.
  • Lactation: Women infected with HIV-1 should be instructed not to breastfeed, due to the potential for HIV-1 transmission.

Indication

DESCOVY® is indicated in combination with other antiretroviral (ARV) agents for the treatment of HIV-1 infection in patients 12 years and older.

Limitations of Use:
DESCOVY is not indicated for use as pre-exposure prophylaxis (PrEP) to reduce the risk of acquiring HIV-1 infection.

*Administered in combination with EVG and COBI as an STR.
Multi-tablet regimens included the following third agents: ATV + RTV, DRV + RTV, LPV + RTV, EFV, NVP, RPV, DTG, RAL, or MVC.3,4
Third agents also included EVG + COBI (as an STR), EFV (as an STR), ATV + COBI, or ATV + RTV.2,5
§Median UPCR was 61.4 mg/g at baseline in patients who switched to FTC/TAF (in combination with elvitegravir and cobicistat as an STR) compared to 60 mg/g in patients who remained on their baseline FTC/TDF-based regimen.4

UPCR, urine protein to creatinine ratio.

References:

  1. Mills A, Arribas JR, Andrade-Villanueva J, et al; for GS-US-292-0109 team. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in antiretroviral regimens for virologically suppressed adults with HIV-1 infection: a randomised, active-controlled, multicentre, open-label, phase 3, non-inferiority study [supplementary appendix]. Lancet Infect Dis. 2016;16(1):43-52.
  2. GENVOYA [package insert]. Foster City, CA: Gilead Sciences, Inc.; 2016.
  3. Gallant JE, Daar ES, Raffi F, et al. Efficacy and safety of tenofovir alafenamide versus tenofovir disoproxil fumarate given as fixed-dose combinations containing emtricitabine as backbones for treatment of HIV-1 infection in virologically suppressed adults: a randomised, double-blind, active-controlled phase 3 trial. Lancet HIV. 2016;3(4):e158-e165.
  4. Data on file. Gilead Sciences, Inc.
  5. Mills A, Arribas JR, Andrade-Villanueva J, et al; GS-US-292-0109 team. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in antiretroviral regimens for virologically suppressed adults with HIV-1 infection: a randomised, active-controlled, multicentre, open-label, phase 3, non-inferiority study. Lancet Infect Dis. 2016;16(1):43-52.

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