Market sputtering for impotence drugs

By Scott Hensley,, Jeanne Whalen and Leila Abboud

The Wall Street Journal

The sexual revolution that Viagra sparked almost seven years ago is sputtering.

Pfizer's blue, diamond-shaped pill established that impotence could be treated easily and on demand. Companies and many doctors had predicted an explosion in treatment after the introduction of rival pills Cialis, from Lilly ICOS, and Levitra, marketed by GlaxoSmithKline Bayer. But the surge didn't happen.

"The growth since the competition came to the market has been modest and below expectations for the entire class," said Patrick Holmes, a Pfizer marketing vice president for drugs including Viagra.

Once the only pill in town, Viagra has seen its market share of new prescriptions for impotence slip to about 65 percent of U.S. prescriptions for October and November last year, according to NDC Health, Atlanta. Market share for Cialis, launched in November 2003, climbed to nearly 21 percent of new prescriptions for the same two-month period in 2004. Levitra, launched in August 2003, had about 13 percent of new prescriptions in the two-month period, down from 15 percent in the first quarter of 2004. But total sales in the United States have been flat at a little more than $1 billion for the past two years.

Cialis passed Levitra, in terms of share and new prescriptions, in the second quarter of 2004. A key reason: Cialis lasts as long as 36 hours, instead of four hours or so for Viagra and Levitra. Levitra and Viagra take effect more quickly than Cialis. Some men have less success with Levitra than with Viagra because Levitra isn't always absorbed as well in the body, some doctors say.

In a sign that all is not well in the impotence-drug market, Britain's GlaxoSmithKline said Monday that it was selling marketing rights to Levitra outside the United States back to its marketing partner on the drug, Bayer, of Germany, for $272 million. A Glaxo spokesman in London said the erectile-dysfunction market hadn't grown as fast as the company had hoped, particularly outside the United States, and that it was tough to sell the drugs without the help of consumer ads, which are banned for prescription drugs in most places outside the United States. Glaxo said it remains committed to promoting the drug in the United States.

The number of men taking drugs to treat impotence hasn't changed much lately, despite a surge in advertising and promotion. Pfizer spent $88 million to advertise Viagra to U.S. consumers during the 10 months ending in October, according to TNS Media Intelligence/CMR. During the same period, Cialis' ad spending was $137 million, followed by $133 million for Levitra.

Glaxo co-markets Levitra in the United States with Schering-Plough Corp.

Several different consumer ad campaigns have promoted Levitra since its U.S. launch in August 2003. The most recent television campaign, called "My Man," featured a young woman talking about the positive effect Levitra had on her relationship. In print ads, Levitra is touted as fast-acting, helping to deliver an erection within 10 minutes for some men and within 25 minutes for most men. Levitra is also a sponsor of the National Football League.

Pfizer pulled its Viagra television ads late last year after the Food and Drug Administration objected to the lack of side effect information in them. Possible side effects include prolonged and painful erections. Pfizer declined to comment on when the ads might resume, citing continuing negotiations with the FDA.

Dr. Andrew McCullough, a urologist and director of male sexual health and fertility at New York University Medical Center, has studied and prescribes all three medicines. He figures 6 million to 7 million men have taken them.

Some estimates put the number of U.S. men with problems attaining or maintaining erections at 30 million. McCullough says the number of men who are "interested in being treated is probably half" of those affected by impotence problems, which can be a signal of serious disease, including clogged arteries or high blood pressure, he said.

The reasons for the treatment gap are myriad. Some men's partners aren't interested in solving the problem.

And many doctors are as hesitant as their patients to bring up the impotence question. There's a "huge untapped market that will remain so until there's a shift in the mind-set," McCullough said.

Glaxo said a big problem for Levitra and the entire category is the free pills that doctors give patients.

David Pernock, a senior vice president for Glaxo, says the company's research shows that millions more men are asking their doctors about impotence lately. But free samples made up 54 percent of the impotence pills actually taken by patients in the first half of 2004, he says.

"Frequently, the doctor is giving all three products out, and that's enough to keep the guy satisfied for a while," Pernock said.