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To: Anthony Wong who wrote (1346)1/23/1999 5:00:00 AM
From: Anthony Wong  Respond to of 1722
 
BBC: Viagra risks unproven
Thursday, January 21, 1999 Published at 12:48 GMT

Viagra's possible side-effects are well publicised

Almost 200 people around the world have died after
taking Viagra, but it has not yet been proven if the drug
is directly responsible for the deaths.

Some 130 deaths in the US are being investigated. Five
people in the UK and at least 54 others worldwide have
died after taking the drug.

Viagra does have side effects. It carries a warning that it
should not be used in conjunction with nitrate drugs as
combining the drugs could lower blood pressure to
dangerous levels.

Patients who ignore the advice put their lives at risk as
the drug has been linked to sudden death in such
patients with such pre-existing risk factors.

The drug can also affect an enzyme in the retina,
causing a temporary blue visual tinge, and has been
associated with headaches and stuffy noses.

Latest figures

It emerged last weekend that five people had died
following Viagra use in the UK.

Overall it has been linked with 41 cases of adverse
reactions between 1 July and 22 December, according to
figures from the Medicines Control Agency.

The reactions ranged from
skin rashes to major
problems such as heart
attacks.

In 11 cases men taking the
drug suffered heart disorders,
four of whom died. But there
is no indication whether they
already had heart disease or
were taking other drugs for a
heart problem. The fifth death
was a suicide.

In the US, 130 patients are known to have died after
taking drug between late March and mid-November 1998,
according to the Food and Drug Administration.

This figure excluded reports referring to "55 foreign
patients, 35 with unverifiable information (from hearsay,
rumour, the media, or unidentifiable reporters), and 22
with unconfirmed Viagra use".

During the period covered, more than six million
outpatient prescriptions - representing about 50 million
tablets - were dispensed.

Pre-existing conditions

The FDA said 77 of these men died of heart problems,
three had strokes and in the other 48 cases cause of
death was unknown.

The other two cases were accounted for by "homicide
and drowning".

Excluding the last two cases, the patient died within four
to five hours of taking Viagra in 34% of the deaths.

However, most of the patients who died had other risk
factors.

The FDA report says: "Ninety (70%) of the 128 patients
had one or more risk factors reported for cardiovascular
or cerebrovascular disease (hypertension,
hypercholesterolemia, cigarette smoking, diabetes
mellitus, obesity, previous cardiac history).

"Three additional persons without identified heart disease
or risk factors had severe coronary artery disease
detected at autopsy."

The FDA updated the label information for Viagra in light
of these findings

The label for Viagra in the US and in Europe clearly says
that people taking nitrate-based treatments or with
pre-existing heart conditions should not take the drug.

Case histories

In September, the Lancet medical journal reported one
case where it was thought taking Viagra had caused a
heart attack.

The report said that half an
hour after taking Viagra, the
man began to experience
severe chest pains. He has
since made a full recovery.

The researchers, led by Dr J
Feenestra of the Dutch Drug
Safety Unit, said the
65-year-old man's collapse
appeared to have been
triggered solely by taking the
drug.

He had no risk factors for
heart attack and had not even had a chance to test the
much-hyped drug before his collapse.

Dr Feenestra concluded: "The close temporal relation
between ingesting sildenafil [Viagra] and the onset of
severe chest pain due to acute myocardial infarction
[heart attack]...suggests that sildenafil was causally
related."

However, Pfizer, the company that makes Viagra,
accused the Lancet of publicity seeking and said that
the case reported one heart attack in more than three
million users.

Risk factors

Dr Gill Samuels, credited as the inventor of Viagra,
spoke to the BBC in December when it was known that
there had been 69 deaths in the US and a total of 123
worldwide.

She said: "Unfortunately a number of men have died after
taking Viagra. Any death is a tragedy, and we are
always concerned when there are reports of serious
adverse events associated with the use of any of our
pharmaceuticals. But to my knowledge none of these
deaths have been directly attributable to Viagra.

"One thing that we have to remember is that we are
talking about approximately 130 deaths among over
3,000,000 men who have received Viagra.

"Many of them are older and often have another disease
such as heart disease, kidney disease or diabetes.
When you resume sexual activity that can actually place
a strain on the heart. It is exercise and it does increase
cardiac workload."

news.bbc.co.uk



To: Anthony Wong who wrote (1346)1/23/1999 5:07:00 AM
From: Anthony Wong  Respond to of 1722
 
Merck Ends Testing of Substance P Depression Drug (Update3)

Bloomberg News
January 22, 1999, 7:24 p.m. ET

Merck Ends Testing of Substance P Depression Drug (Update3)

(Adds analyst comment, background)

Whitehouse Station, New Jersey, Jan. 22 (Bloomberg) -- Merck
& Co., the world's biggest drugmaker, halted tests of an
experimental antidepressant it was counting on to help make up
for loss of patent protection on some of its best-selling drugs.

Merck fell 7 5/16 to 139 after it announced the end of
testing for MK-869 drug against depression. Early studies didn't
provide enough evidence the drug works as an anti-depressant.
Instead, Merck will continue testing it for use in nausea in
cancer patients.

The drug, which works on a brain chemical known as substance
P, was seen as one of Merck's best prospects for offsetting the
loss of patents by 2001 on four drugs with more than $5 billion
in combined annual sales. These drugs include Vasotec with more
than $2 billion in annual sales.

''It's a major setback for Merck,'' said Mike Krensavage, an
analyst with Brown Brothers Harriman, who has a short-term
''neutral'' rating on Merck. ''The insurance policy they were
going to use against the patent exposures has been canceled.''

Merck has said it intends to rely on its own laboratories
and its alliances with smaller partners to come up with the new
products needed to get through the patents losses. Some of
Merck's rivals, such as Astra AB, instead are merging with other
drugmakers as patent losses near.

Still, analysts have not been impressed with the new
products Merck has introduced recently. Merck started sales of
five new medicines in 1998, including the once-a-day asthma
medicine Singulair, the anti-baldness pill Propecia and heart
drug Aggrastat. Although Singulair has done well, this crop of
new drugs might not provide an immediate replacement for
Vasotec's sales.

Merck Vulnerable

''Merck's in a very vulnerable position,'' said Alex Zisson,
an analyst with Hambrecht & Quist, who has a ''neutral'' rating
on Merck. ''Some of their launches, like Propecia and Aggrastat,
haven't done well.''

Now, Merck is looking to one drug alone, its experimental
painkiller Vioxx, analysts said. Vioxx, which is waiting for U.S.
approval, is part of a new class of drug that appear to treat
pain and inflammation without irritating the stomach as does
aspirin and other painkillers.

Rival Monsanto Co. last month won U.S. Food and Drug
Administration approval of a similar drug, Celebrex. It intends
to introduce the drug in late February, although doctors already
are writing prescriptions for it.

Relying on Vioxx

''Without MK-869, Merck will have to rely even more on Vioxx
and it's not good,'' to depend so much on one product, Krensavage
said.

Not only does Monsanto have a head start on Merck, Monsanto
has chosen a marketing partner, Pfizer Inc., that already has
beaten Merck in the marketing battle for a key drug.

Pfizer, which will work with Monsanto to sell Celebrex,
also helps Warner-Lambert Co. sell its cholesterol-reducing drug
Lipitor. Pfizer's assistance helped make Lipitor's 1997
introduction the best ever in the U.S. drug industry, a
record broken only by the 1998 introduction of Pfizer's impotence
pill Viagra.

Merck halted testing of MK-869 after the second of three
phases of testing needed to apply for U.S. Food and Drug
Administration approval of a drug.

In a release, the company said phase II trials of the
compound ''suggest'' it has anti-depressant activity, but that
the drug's effect was not significantly better than the effect
seen with a placebo sugar pill.

Merck's earlier studies had led investors and analysts to
speculate the drug might someday rival some of the world's top-
selling drugs, such as SmithKline Beecham Plc's Paxil. Depression
drugs are among the world's top-sellers. Eli Lilly & Co.'s Prozac
has annual sales of more than $2 billion.

''It's not good news, to say the least,'' said Hemant Shah,
an independent pharmaceutical analyst. ''This was regarded by
many analysts as the next big multibillion-dollar drug, mostly
because of its depression use,'' he said.

Building Expectations

Merck began building expectations for MK-869 in December
1997, taking the unusual step of highlighting early research
about the compound at its analyst meeting. Merck touted its
experimental drug ''as better than Prozac,'' Shah said.

Merck said today in a release that as it pursues development
of MK-869 for nausea, it will continue early trials of a
different, more potent compound that has shown promise in
treating depression.

A study published this week in the prestigious New England
Journal of Medicine found MK-869 to be effective at neutralizing
the waves of nausea and vomiting that most often strike cancer
patients as they are undergoing chemotherapy.

--Kristin Reed in Washington (202) 624-1858 and Kerry Dooley in



To: Anthony Wong who wrote (1346)1/23/1999 5:15:00 AM
From: Anthony Wong  Respond to of 1722
 
Merck 4th-Qtr Profit Seen at $1.16 a Share: Earnings Outlook

Bloomberg News
January 22, 1999, 2:38 p.m. ET

Merck 4th-Qtr Profit Seen at $1.16 a Share: Earnings Outlook

Expected Earnings

Merck & Co.'s fourth-quarter earnings are expected to rise
to $1.16 a share from $1.01 a share, based on the average
estimate of analysts surveyed by First Call Corp. The world's
biggest drugmaker introduced five new medicines in 1998,
including ones to treat baldness and asthma.

Time

Whitehouse Station, New Jersey-based Merck plans to release
its earnings Tuesday before the market opens.

Behind the Numbers

In the fourth quarter, Merck started a money-back guarantee
on its top-selling drug, the cholesterol reducer Zocor for some
patients. The offer is intended to help Zocor better compete with
Warner-Lambert Co.'s rival drug, Lipitor.

Although Merck can make better claims about Zocor's ability
to prevent heart problems than Warner-Lambert can, many doctors
have preferred Lipitor. The Warner-Lambert drug seems to reduce
cholesterol more efficiently at lower doses.

The threat to Zocor comes as Merck faces the loss of patents
by 2001 on four drugs with more than $5 billion in combined
annual sales. Merck intends to offset the expected declines in
sales of those drugs, including the high blood pressure medicine
Vasotec, by introducing new products. In 1998, Merck started
sales of the anti-baldness pill Propecia, the once-a-day asthma
pill Singulair and three other new drugs.

Merck's third-quarter results raised concerns about how well
this strategy is working. Merck raised reported third-quarter
sales by counting sales from the Astra Merck joint venture as
revenue instead of equity income for the first time. The change
made U.S. sales growth seem a few percentage points higher than a
strict quarter-to-quarter comparison would be, analysts said.
Third-quarter sales rose less than 10 percent, excluding Merck's
prescription-management unit Medco and the change for Astra Merck
sales, analysts said.

What the Experts Say

''We're looking at the clouds that could come by 2001,''
said David Saks, an analyst with Gruntal & Co., who has a ''buy''
rating on Merck. ''Merck really needs to show double-digit sales
growth in the fourth quarter. It could really sparkle if it
delivers that momentum.''

Previous Market Reaction

Merck rose 2 3/4 to 136 on Oct. 16 after reporting net
income rose 14 percent to $1.37 billion, or $1.12 a share. It had
been expected to earn $1.11 a share, the average estimate of
analysts polled by First Call Corp.

Market Performance

Merck has risen 8.4 percent to 147 1/2 since Oct. 16.

--Kerry Dooley in the Princeton newsroom (609) 279-4016/shw



To: Anthony Wong who wrote (1346)1/23/1999 5:21:00 AM
From: Anthony Wong  Read Replies (2) | Respond to of 1722
 
Eli Lilly Prozac patent challenge starts Jan. 25
Friday January 22, 7:12 pm Eastern Time

By Greg Jefferson

INDIANAPOLIS, Jan 22 (Reuters) - The lawsuit threatening Eli Lilly and Co.'s (NYSE:LLY - news) patents on its blockbuster antidepressant drug Prozac, which brings in about a third of its revenues, is set to open on January 25 in U.S. District Court in Indianapolis.

The patents are being challenged by generic drug makers Barr Laboratories Inc. (NYSE:BRL - news) and Geneva Pharmaceuticals Inc. The patent on the drug itself, fluoxetine hydrochloride, currently expires in 2001. The other, covering its use, ends at the end of 2003.

The trial ''is extremely important for Lilly,'' said drug industry analyst James Keeney of ABN AMRO in New York.

Prozac provided Lilly with $2.6 billion of its $8.5 billion in revenues in 1997, and more than $2 billion in the first nine months of 1998. Lilly has not yet reported 1998 year results.

The litigation has been in the works for nearly two years.

Barr filed with the U.S. Food and Drug Administration to market a generic version of the antidepressant in December 1996. The following April, Lilly sued to block the Pomona, New York-based firm.

Later in 1997, Lilly filed a separate lawsuit against Geneva, a Colorado-based subsidiary of Swiss pharmaceutical company Novartis AG . Geneva had also filed with FDA to sell generic fluoxetine.

The cases were later consolidated.

In a sheaf of pretrial rulings handed down on January 12, U.S. District Judge Sarah Evans Barker narrowed the case, throwing out Barr's claims against the double-patenting of Prozac and allegations that Lilly did not supply the U.S. Patent Office with the ''best mode'' for making Prozac.

Many industry watchers interpreted these rulings as favoring Lilly.

Remaining are Barr's claim that Lilly scientists did not invent fluoxetine and the charge of ''inequitable conduct'' on Lilly's part in securing the Prozac patents.

''It looks like this trial will be in Lilly's favor,'' said Cynthia Beach, a pharmaceuticals industry analyst for Gerard Klauer Mattison in New York. ''Their strongest claim -- on double-patenting -- won't even be heard.''

Lilly spokesman Ed West contends Barr will have a heavy burden in court.

''We believe -- and we believe past patent cases bear this out -- that the allegation of inequitable conduct is very difficult to prove,'' West said. ''That's a very difficult standard for Barr to meet.''

Barker will rule on the two claims. But her decisions will probably not be the last word in the case.

The January 12 rulings could be fodder for an appeal by Barr if the company loses the trial, expected to last two weeks.

''From my understanding, the (dismissal) of the double-patenting issue is very appealable,'' said Barr spokeswoman Carol Cox. ''I anticipate we'll appeal on both.''

In a January 21 conference call, Barr Chairman, President and Chief Executive Officer Bruce Downey, told investors an appeal is likely, Cox said. Word spread that day and Lilly's share price dropped $4.19 to $78.06.

In Lilly's camp, attorneys are concentrating only on winning the case, West said.

"We will address any other scenario at a future time," he added.