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All things Pharma

Erectile Dysfunction – Is Three a Crowd?

ince its launch in March 1998 Viagra has revolutionised the erectile dysfunction (ED) market. A blockbuster drug since its inception, the blue diamond-shaped pill had been the only name in town for over five years. But with GlaxoSmithKline (GSK) and Bayer introducing Levitra to the U.S. market and Cialis from Eli Lilly and ICOS just receiving FDA approval, will they cannibalise Viagra’s sales or expand the ED market? Erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse. The successful introduction of Viagra, the first phosphodiesterase (PDE) inhibitor, by Pfizer resulted in a substantial increase in men willing to acknowledge ED and seek treatment from their doctors. Viagra is safe and well tolerated, but it does not seem to work in all men. In addition, only 10 percent of the patient population suffering from ED uses Viagra. This huge untreated ED population represents a significant opportunity for the newer players. Levitra and Cialis, the second generation of PDE agents, will provide men with additional options for the treatment of ED.

New Kids on the Block

Cialis and Levitra possess several traits that make them better than Viagra. Cialis is known as “the weekend pill” because it can last as long as 36 hours compared to four hours for Viagra. This long lasting effect is the focus of its marketing campaign. It is also the only pill that can sustain efficacy after a meal. Viagra must be taken on an empty stomach. Men can take a pill on Friday and expect a weekend of enjoyment, providing flexibility that Viagra cannot offer. Levitra is the choice for those that are more spontaneous because it takes the least time to work because it has the highest specificity. It works within 16 minutes while Viagra takes 30 minutes to an hour. Cialis and Levitra offer men with various comorbidities treatment options. Men with enlarged prostates can take Cialis with Flomax, while Levitra works better in diabetes patients suffering from impotence.

Viagra Still King

Viagra is one of the most recognisable brands in the pharmaceutical industry and synonymous with erectile dysfunction. GSK/Bayer and Lilly ICOS will find it extremely challenging to win a marketing battle against Pfizer. Viagra also has a good track record and established clinical data backing it up, unlike its two new rivals. A strong brand goes a long way towards preserving revenues and many doctors and patients have fierce loyalty to products that have served them well in the past. There has been no U.S. clinical trial data published directly comparing the use of either Cialis or Levitra with Viagra. Despite the long lasting effect of Cialis and fast onset of Levitra, they are not that different from Viagra. All three drugs are PDE-5 inhibitors that work on the same enzyme. All three drugs have 70 percent effectiveness. They have side effects such as headaches, upset stomachs, nasal stuffiness and nitrate contraindications in common. The cost of therapy is not significantly different. Viagra is currently the first-line treatment for ED and this does not look to change for the foreseeable future.

Room for Everyone

The advances Cialis and Levitra make will not come at the expense of Viagra but from expanding the market since they can reach parts of the patient population for which Viagra is not a viable option. The potential of the ED market is in its size. As the population continues to age the potential market will only grow in size. These new products entering the market with extensive promotional and sales campaigns behind them will only amplify awareness and discussion concerning ED, making it much easier for patients to consult their doctors. The launch of the two new drugs in Europe has expanded the market. Erectile dysfunction is highly prevalent and a vastly underserved market. Getting men to seek medical help is the biggest challenge. If GSK/Bayer and Lilly ICOS succeed in bringing more men to their doctors’ offices they both can eventually achieve blockbuster status.


Frost & Sullivan, an international consultancy firm, has been supporting clients’ growth for over four decades. Our market expertise covers a broad spectrum of industries, while our portfolio of advisory competencies include strategic consultancy, market intelligence and management training. Our mission is to work with our clients’ management teams to deliver market insights and to create value and drive growth through innovative approaches. Frost & Sullivan’s network of more than 500 consultants, industry experts, corporate trainers and support staff, spans the globe with 19 offices worldwide.

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