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The World's 10 Best-Selling Drugs

NEW YORK - For the first time ever, global spending on prescription drugs has topped $600 billion, even as growth slowed in Europe and North America.

Worldwide sales of prescription medicines worldwide rose 7% to $602 billion, according to IMS health, a pharmaceutical information and consulting company. The United States still accounts for the lion's share of that, with $252 billion in annual sales, but sales in it and the other nine biggest markets grew by only 5.7%. But emerging markets such as China, Russia, South Korea and Mexico outpaced those markets, growing a whopping 81%.

"While these markets are a small part of the total marketplace, that's where the growth is expected to come from," says Murray Aitken, senior vice president of corporate strategy at IMS.
Pfizer's cholesterol pill Lipitor remains the best-selling drug in the world for the fifth year in a row. It's annual sales were $12.9 billion, more than twice as much as its closest competitors: Plavix, the blood thinner from Bristol-Myers Squibb and Sanofi-Aventis; Nexium, the heartburn pill from AstraZeneca; and Advair, the asthma inhaler from GlaxoSmithKline.

One thing that's visibly lacking from the list of international bestsellers is a biotech drug. In the U.S., three anemia treatments, two from Amgen and one from Johnson & Johnson, have cracked the top ten. But the biotech revolution brought by drugs made of protein that must be injected hasn't had quite the same impact worldwide--although the category still grew 17% to $53 billion. Most of the drugs on the list are small molecules, the same kind of chemicals, resembling German dyes, that kick started the drug business into existence at the turn of the last century.

But right now, big drug companies are suffering from an innovation drought. Aitken says that there were only 30 new medicines launched in key markets in 2005, well off the peak of the 1990s. A more encouraging sign: There are 2,300 experimental drugs being tested in humans. In the late stages of human testing, IMS counts 96 cancer drugs, 51 heart treatments, 37 antivirals and 28 potential medicines for arthritis or pain. However, more and more drugs are being developed by biotech--though Aitken argues that this is less of a problem than people think.

"Let's not rewrite history in terms of where the innovations of 10 years ago came from," Aitken says. Many of them, he notes, came from Japanese companies, like cholesterol pill Pravachol, or academia, like the cancer drug Taxol. Both of those became huge sellers for Bristol-Myers Squibb.

Another difficulty for big pharma: There are lots of $1 billion drugs, but few mega-blockbusters. The second-biggest drug generates half as much revenue as Lipitor, and the tenth top-selling drug, Wyeth's anti-depressant Effexor, generates a "mere" $3.8 billion. That means even if new medicines are successful, they may not fill the holes created as drugs go generic.

That's one reason why Bristol and Sanofi were under pressure to reach a settlement in their Plavix patent dispute with generic drugmaker Apotex, announced late last night.

However, Aitken highlights the potential of several new medicines launched in the past year, including diabetes treatment Byetta, co-marketed by Eli Lilly and Amylin Pharmaceuticals, as well as Lunesta, an insomnia drug made by Sepracor. And there are more on the way he says are worth watching. The two key drug launches this year are of Sutent, Pfizer's first big entry into cancer drugs, and Acomplia, the anti-obesity pill being developed by Sanofi-Aventis.

Sutent is already on the market, although sales data are not yet available. Acomplia has been delayed at the U.S. Food and Drug Administration and rejected as a stop-smoking drug. Some cardiologists, who are excited about the drug because of its potential to reduce the risk of heart disease, are also worried about side effects.

Acomplia works by blocking the same brain receptor that makes pot smokers hungry; psychiatric symptoms like anxiety are one of the most common reasons patients stopped taking Acomplia in clinical trials. "It's a pill that blocks the 'happy receptor'," worries Prediman K. Shah of Cedars Sinai Medical Center. "The main reason for concern is that it might have an adverse impact on depression or suicide." He is nonetheless very excited about the pill.


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