VEMLIDY: An improved bone safety profile

Across multiple trials, VEMLIDY demonstrated both reduced impact and improvements in bone mineral density.1,2

Pivotal trials 108 & 110 design

The efficacy and safety of VEMLIDY 25 mg once daily in the treatment of CHB in adults with compensated liver disease were evaluated in 2 randomized, double-blind, active-controlled, noninferiority trials: Trial 108 (N=425 HBeAg– treatment-naïve and treatment-experienced patients) and Trial 110 (N=873 HBeAg+ treatment-naïve and treatment-experienced patients).1,3,4,a

The primary efficacy endpoint for both trials was the proportion of patients with plasma HBV DNA levels below 29 IU/mL at Week 48. Additional efficacy endpoints evaluated at Week 48, Week 96, and Week 144 for both studies include the proportion of patients with HBV DNA >29 IU/mL, alanine aminotransferase (ALT) normalization, and hepatitis B surface antigen (HBsAg) loss and seroconversion. Hepatitis B envelope antigen (HBeAg) loss and seroconversion were also assessed in Trial 110.1-4 In the original protocol, patients were randomized to VEMLIDY or TDF 300 mg once daily in the double-blind phase for 96 weeks, followed by an open-label VEMLIDY phase through Week 144.2 The original protocol was amended to extend the double-blind phase from 96 weeks to 144 weeks, followed by an open-label phase through Week 384.5 However, before implementation of the amendment protocol, 540 patients entered the open-label phase at Week 96 (n=360 remained on VEMLIDY and n=180 switched from TDF to VEMLIDY).b At Week 144, all 1,137 remaining HBeAg– and HBeAg+ patients (out of the original 1,298) entered the open-label VEMLIDY phase for an extension trial that is still ongoing.6
See baseline characteristics

aKey inclusion criteria: HBV DNA >20,000 IU/mL; ALT >60 U/L for men and >38 U/L for women (2x ULN based on the 2016 AASLD criteria).4,7 bThe numbers of patients listed after Week 96 refer to those who entered the open-label phase or remained in the double-blind phase, and exclude patients who prematurely discontinued double-blind trial treatment by Week 96.6

In a pooled analysis of Studies 108 and 110, patients receiving VEMLIDY experienced a significant mean percentage change from baseline in spine and hip BMD vs TDF at Weeks 96 and 1441,2,5:

  • 71% and 75% smaller mean decrease in spine BMD at Weeks 96 and 144, respectively
  • 87% and 84% smaller mean decrease in hip BMD at Weeks 96 and 144, respectively

Decrease in BMD from baseline at Weeks 96 and 1441,2

Charts depicting impact on BMD at the spine with VEMLIDY® (tenofovir alafenamide) vs TDF (tenofovir disoproxil fumarate) Charts depicting impact on BMD at the spine with VEMLIDY® (tenofovir alafenamide) vs TDF (tenofovir disoproxil fumarate)

BMD decline at lumbar spine
(patients with ≥5% decline)1,2

11% (VEMLIDY) vs 25% (TDF) at Week 96

12% (VEMLIDY) vs 24% (TDF) at Week 144

Charts depicting impact on BMD at the hip with VEMLIDY® (tenofovir alafenamide) vs TDF (tenofovir disoproxil fumarate) Charts depicting impact on BMD at the hip with VEMLIDY® (tenofovir alafenamide) vs TDF (tenofovir disoproxil fumarate)

BMD decline at femoral neck
(patients with ≥7% decline)1,2

5% (VEMLIDY) vs 13% (TDF) at Week 96

9% (VEMLIDY) vs 16% (TDF) at Week 144

TDF=tenofovir disoproxil fumarate. cThe Week 144 analysis did not include the 66 patients from the TDF group in Study 108 and the 114 patients from the TDF group in Study 110 who had rolled over from double-blind TDF to open-label VEMLIDY at Week 96 prior to the study amendment.2

BMD decline at lumbar spine1,2
(patients with ≥5% decline)

11% (VEMLIDY) vs 25% (TDF) at Week 96

12% (VEMLIDY) vs 24% (TDF) at Week 144

BMD decline at femoral neck1,2
(patients with ≥7% decline)

5% (VEMLIDY) vs 13% (TDF) at Week 96

9% (VEMLIDY) vs 16% (TDF) at Week 144

  • The long-term clinical significance of these BMD changes is not known1

Effects of VEMLIDY and TDF were compared in a pooled analysis of patients on open-label treatment from Week 96 through Week 144 (48-week safety data)1,2,d:

Improvement in spine and hip BMD at Week 1441,2

Graph depicting change in spine BMD from baseline Graph depicting change in spine BMD from baseline
Graph depicting change in hip BMD from baseline Graph depicting change in hip BMD from baseline
dThe graphs show changes in BMD from baseline for the subset population of patients who entered the open-label phase at Week 96.

Mean percentage change in lumbar spine BMD from Week 96 to Week 1201

+0.6%
Patients who remained on VEMLIDY
+1.7%
Patients who switched from TDF to VEMLIDY

Mean percentage change in total hip BMD from Week 96 to Week 1201

0%
Patients who remained on VEMLIDY
+0.6%
Patients who switched from TDF to VEMLIDY
  • The long-term clinical significance of these BMD changes is not known1

ROBERT GISH, MD

World-renowned expert in hepatology
Longstanding leader in AASLD, EASL, APASL, and the American Society of Transplantation

Explore additional VEMLIDY open-label safety data in this presentation by Dr. Gish.

Robert Gish, MD

World-renowned expert in hepatology

Longstanding leader in AASLD, EASL, APASL, and the American Society of Transplantation

Explore additional VEMLIDY open-label safety data in this presentation by Dr. Gish.

Watch the previous video on clinical data through year 3.
  1. Agarwal K, Brunetto M, Seto WK, et al. 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection. J Hepatol. 2018;68:672-681.
  2. American Association for the Study of Liver Diseases. Posters (Abstracts 301-2389). Hepatology. 2018;68:S184-S1353.
  3. Buti M, Gane E, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol. 2016;1:196-206.
  4. Chan HLY, Fung S, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol. 2016;1:185-195.
  5. Chan HLY, Lim YS, Seto WK, et al. 3-year efficacy and safety of tenofovir alafenamide compared with tenofovir disoproxil fumarate in HBeAg-negative and -positive patients with chronic hepatitis B. Poster presented at: AASLD 2018; November 9-13, 2018; San Francisco, CA. Poster 381.
  6. Chan HLY, Marcellin P, Pan CQ, et al. No resistance to tenofovir alafenamide detected through 144 weeks of treatment in patients with chronic hepatitis B. Poster presented at: AASLD 2018; November 9-13, 2018; San Francisco, CA. Poster 386.
  7. Data on file. Gilead Sciences, Inc.
  8. Seto WK, Buti M, Izumi N, et al. Bone and renal safety are improved in chronic HBV patients 1 year after switching to tenofovir alafenamide from tenofovir disoproxil fumarate. Poster presented at: AASLD 2018; November 9-13, 2018; San Francisco, CA. Poster 404.
  9. VEMLIDY Prescribing Information, Foster City, CA: Gilead Sciences, Inc.; February 2019.

Adverse Reactions

Most common adverse reactions for VEMLIDY (incidence ≥5%; all grades) were headache, abdominal pain, cough, back pain, fatigue, nausea, arthralgia, diarrhea, and dyspepsia.

IMPORTANT SAFETY INFORMATION

BOXED WARNING: POST TREATMENT SEVERE ACUTE EXACERBATION OF HEPATITIS B

  • Discontinuation of anti-hepatitis B therapy, including VEMLIDY, may result in severe acute exacerbations of hepatitis B. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who discontinue anti-hepatitis B therapy, including VEMLIDY. If appropriate, resumption of anti-hepatitis B therapy may be warranted.

Warnings and Precautions

  • Risk of Development of HIV-1 Resistance in HBV/HIV-1 Coinfected Patients: Due to this risk, VEMLIDY alone should not be used for the treatment of HIV-1 infection. Safety and efficacy of VEMLIDY have not been established in HBV/HIV-1 coinfected patients. HIV antibody testing should be offered to all HBV-infected patients before initiating therapy with VEMLIDY, and, if positive, an appropriate antiretroviral combination regimen that is recommended for HBV/HIV-1 coinfected patients should be used.
  • 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 VEMLIDY, there have been no cases of Fanconi syndrome or proximal renal tubulopathy (PRT). Patients with impaired renal function and/or taking nephrotoxic agents (including NSAIDs) are at increased risk of renal-related adverse reactions. Discontinue VEMLIDY in patients who develop clinically significant decreases in renal function or evidence of Fanconi syndrome. Monitor renal function in all patients – See Dosage and Administration.
  • Lactic Acidosis and Severe Hepatomegaly with Steatosis: Fatal cases have been reported with the use of nucleoside analogs, including tenofovir DF. Discontinue VEMLIDY if clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity develop, including hepatomegaly and steatosis in the absence of marked transaminase elevations.

Adverse Reactions

Most common adverse reactions (incidence ≥5%; all grades) were headache, abdominal pain, cough, back pain, fatigue, nausea, arthralgia, diarrhea, and dyspepsia.

Drug Interactions

  • Coadministration of VEMLIDY with drugs that reduce renal function or compete for active tubular secretion may increase concentrations of tenofovir and the risk of adverse reactions.
  • Coadministration of VEMLIDY is not recommended with the following: oxcarbazepine, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, or St. John’s wort. Such coadministration is expected to decrease the concentration of tenofovir alafenamide, reducing the therapeutic effect of VEMLIDY. Drugs that strongly affect P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) activity may lead to changes in VEMLIDY absorption.

Consult the full prescribing information for VEMLIDY for more information on potentially significant drug interactions, including clinical comments.

Dosage and Administration

  • Testing Prior to Initiation: HIV infection.
  • Prior to or when initiating, and during treatment: On a clinically appropriate schedule, assess serum creatinine, estimated creatinine clearance, urine glucose, and urine protein in all patients. In patients with chronic kidney disease, also assess serum phosphorus.
  • Dosage in Adults: 1 tablet taken once daily with food.
  • Renal Impairment: Not recommended in patients with end stage renal disease (ESRD; eCrCl <15 mL/min) who are not receiving chronic hemodialysis; in patients on chronic hemodialysis, on hemodialysis days, administer VEMLIDY after completion of hemodialysis treatment.
  • Hepatic Impairment: Not recommended in patients with decompensated (Child-Pugh B or C) hepatic impairment.

INDICATION

VEMLIDY is indicated for the treatment of chronic hepatitis B virus (HBV) infection in adults with compensated liver disease.

Please click here to see full Prescribing Information for VEMLIDY, including BOXED WARNING.