Odefsey (rilpivirine/emtricitabine/tenofovir alafenamide) is indicated in the treatment of patients aged 12 years and over and weighing at least 35kg who are infected with HIV-1 without known mutations associated with resistance to NNRTIs, tenofovir or emtricitabine and who have a viral load ≤100,000 HIV-1 RNA copies/ml. The 25mg/200mg/25mg tablet should be taken once daily with food.
Gilead also markets Eviplera, a similar product containing rilpivirine 25mg and emtricitabine 200mg but with a different tenofovir salt (tenofovir disoproxil 245mg).
Tenofovir alafenamide is a novel targeted prodrug of tenofovir which has high antiviral efficacy similar to tenofovir disoproxil but at a significantly lower dose (25mg versus 245mg).
As a result, Odefsey may be used in patients with moderate renal impairment (CrCl ≥30ml/min) while Eviplera is contraindicated if creatinine clearance is below 50ml/min. In addition, Eviplera is associated with a risk of reduced bone mineral density, especially when used in combination with a boosted protease inhibitor and alternative regimens should be considered in patients with osteoporosis and a high fracture risk. No such warning applies to the use of Odefsey.