Cited by 428HIV/AIDS Research and InterventionsHIV/AIDS drug development and treatmentHIV Research and Treatment

Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER) primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial

Open access
Mayer, Kenneth H, Molina, Jean-Michel, Thompson, Melanie A, Anderson, Peter L, Mounzer, Karam C, De Wet, Joss J, DeJesus, Edwin, Jessen, Heiko +16 more·2020·The Lancet

Abstract

Background Tenofovir alafenamide shows high antiviral efficacy and improved renal and bone safety compared with tenofovir disoproxil fumarate when used for HIV treatment. Here, we report primary results from a blinded phase 3 study evaluating the efficacy and safety of pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir alafenamide versus emtricitabine and tenofovir disoproxil fumarate for HIV prevention.Methods This study is an ongoing, randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial done at 94 community, public health, and hospital-associated clinics located in regions of Europe and North America, where there is a high incidence of HIV or prevalence of people living with HIV, or both. We enrolled adult cisgender men who have sex with men and transgender women who have sex with men, both with a high risk of acquiring HIV on the basis of their self-reported sexual behaviour in the past 12 weeks or their recent history (within 24 weeks of enrolment) of bacterial sexually transmitted infections. Participants with current or previous use of PrEP with emtricitabine and tenofovir disoproxil fumarate were not excluded. We used a computer-generated random allocation sequence to randomly assign (1:1) participants to receive either emtricitabine (200 mg) and tenofovir alafenamide (25 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir alafenamide group), or emtricitabine (200 mg) and tenofovir disoproxil fumarate (300 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir disoproxil fumarate group). As such, all participants were given two tablets. The trial sponsor, investigators, participants, and the study staff who provided the study drugs, assessed the outcomes, and collected the data were masked to group assignment. The primary efficacy outcome was incident HIV infection, which was assessed when all participants had completed 48 weeks of follow-up and half of all participants had completed 96 weeks of follow-up. This full analysis set included all randomly assigned participants who had received at least one dose of the assigned study drug and had at least one post-baseline HIV test. Non-inferiority of emtricitabine and tenofovir alafenamide to emtricitabine and tenofovir disoproxil fumarate was established if the upper bound of the 95·003% CI of the HIV incidence rate ratio (IRR) was less than the prespecified non-inferiority margin of 1·62. We prespecified six secondary bone mineral density and renal biomarker safety endpoints to evaluate using the safety analysis set. This analysis set included all randomly assigned participants who had received at least one dose of the assigned study drug. This trial is registered with ClinicalTrials.gov, NCT02842086, and is no longer recruiting.Findings Between Sept 13, 2016, and June 30, 2017, 5387 (92%) of 5857 participants were randomly assigned and received emtricitabine and tenofovir alafenamide (n=2694) or emtricitabine and tenofovir disoproxil fumarate (n=2693). At the time of the primary efficacy analysis (ie, when all participants had completed 48 weeks and 50% had completed 96 weeks) emtricitabine and tenofovir alafenamide was non-inferior to emtricitabine and tenofovir disoproxil fumarate for HIV prevention, as the upper limit of the 95% CI of the IRR, was less than the prespecified non-inferiority margin of 1·62 (IRR 0·47 [95% CI 0·19-1·15]). After 8756 person-years of follow-up, 22 participants were diagnosed with HIV, seven participants in the emtricitabine and tenofovir alafenamide group (0·16 infections per 100 person-years [95% CI 0·06-0·33]), and 15 participants in the emtricitabine and tenofovir disoproxil fumarate group (0·34 infections per 100 person-years [0·19-0·56]). Both regimens were well tolerated, with a low number of participants reporting adverse events that led to discontinuation of the study drug (36 [1%] of 2694 participants in the emtricitabine and tenofovir alafenamide group vs 49 [2%] of 2693 participants in the emtricitabine and tenofovir disoproxil fumarate group). Emtricitabine and tenofovir alafenamide was superior to emtricitabine and tenofovir disoproxil fumarate in all six prespecified bone mineral density and renal biomarker safety endpoints.Interpretation Daily emtricitabine and tenofovir alafenamide shows non-inferior efficacy to daily emtricitabine and tenofovir disoproxil fumarate for HIV prevention, and the number of adverse events for both regimens was low. Emtricitabine and tenofovir alafenamide had more favourable effects on bone mineral density and biomarkers of renal safety than emtricitabine and tenofovir disoproxil fumarate.Funding Gilead Sciences.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(20)31065-5

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 61 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. [17]Sullivan PS, Smith DK, Mera-Giler R, et al. The impact of pre-exposure prophylaxis with TDF/FTC on HIV diagnoses, 2012–2016, United States. International AIDS Conference; Amsterdam, Netherlands; July 23–27, 2018 (abstr LBPEC036).
  2. [19]Schwartz JL, Cottrell M, Thurman AR, et al. HIV prevention in healthy women: safety and pharmacokinetics of a potential new tenofovir alafenamide fumarate (TAF)-based oral prep regimen. HIV Research for Prevention conference; Madrid, Spain; Oct 21–25, 2018 (presentation OA15.04).
  3. [35]AVAC UNAIDS Good participatory practice: guidelines for biomedical HIV prevention trials, second edition https://www.avac.org/resource/good-participatory-practice-guidelines-biomedical-hiv-prevention-trials-second-edition 2011
  4. [48]Schwartz JL, Cottrell M, Thurman AR, et al. HIV prevention in healthy women: safety and pharmacokinetics of a potential new tenofovir alafenamide fumarate (TAF)-based oral prep regimen. HIV Research for Prevention Conference; Madrid, Spain; Oct 21–25, 2018 (presentation OA15.04).
  5. [49]Walsh JS Henry YM Fatayerji D Eastell R Lumbar spine peak bone mass and bone turnover in men and women: a longitudinal study Osteoporos Int 20 2009 355 362 18629566
  6. [50]Weaver CM Gordon CM Janz KF The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations Osteoporos Int 27 2016 1281 1386 26856587 PMC4791473
  7. [55]Huang Y-LA, Tao G, Smith DK, Hoover KW. Persistence with HIV preexposure prophylaxis in the United States, 2012–2016. Conference on Retroviruses and Opportunistic Infections; Seattle, WA, USA; March 4–7, 2019 (abstr 106).
  8. [56]Mayer K, Levine K, Grasso C, Krakower D, Marcus J. Longer term PrEP users in a Boston community health center: sociodemographic factors and PrEP persistence. Tenth International AIDS Conference on HIV Science; Mexico City, Mexico; July 21–24, 2019 (abstr TUPEC436).
  9. [70]Hill A, Venter WF, Delaporte E, et al. Progressive rises in weight and clinical obesity for TAF/FTC/DTG and TDF/FTC/DTG versus TDF/FTC/EFV: ADVANCE and NAMSAL trials. Tenth International AIDS Conference on HIV Science; Mexico City, Mexico; July 21–24, 2019 (abstr MOAX0102LB).

Cited by

Sorted by citations

Authors
Mayer, K. H., Molina, J.-M., Thompson, M. A., Anderson, P. L., Mounzer, K. C., De Wet, J. J., DeJesus, E., Jessen, H., Grant, R. M., Ruane, P. J., Wong, P., Ebrahimi, R., Zhong, L., Mathias, A., Callebaut, C., Collins, S. E., Das, M., McCallister, S., Brainard, D. M., Brinson, C., Clarke, A., Coll, P., Post, F. A., & Hare, C. B.
Affiliations
  • Harvard University (US)
  • Inserm (FR)
  • AIDS Research Consortium of Atlanta (US)
  • University of Colorado Anschutz (US)
  • Philadelphia Fight (US)
  • Orlando Immunology Center (US)
  • University of California, San Francisco (US)
  • Ruane Medical (US)
  • Gilead Sciences (United States) (US)
  • National Health Service (GB)
  • IrsiCaixa (ES)
  • King's College Hospital NHS Foundation Trust (GB)
  • Kaiser Permanente San Francisco Medical Center (US)
Corresponding author
Das, Moupali
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-07
Volume
396
Issue
10246
Pages
239-254
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W3045256412
Cited by
428
References
61
Citations by year
2026: 38 · 2025: 68 · 2024: 72 · 2023: 76 · 2022: 88 · 2021: 72 · 2020: 13
FWCI
8.17
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Gilead Sciences
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
  • Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
Keywords
HIV pre-exposure prophylaxis, tenofovir alafenamide, tenofovir disoproxil fumarate, emtricitabine, HIV prevention, non-inferiority, men who have sex with men, transgender women, renal safety, bone safety, antiviral efficacy, sexually transmitted infections
MeSH terms
Emtricitabine, Tenofovir, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination, Sexual and Gender Minorities, Adenine, Adult, Double-Blind Method, Europe, Female, Humans, Male, North America, Placebos, Safety, HIV-1, HIV Infections, Prevalence, Treatment Outcome, Homosexuality, Male, Anti-HIV Agents, Pre-Exposure Prophylaxis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review