Yes - it’s time to sing Happy Birthday to the little blue pill that has made such a difference to so many lives. Viagra turns ten years old today. Soon it will be old enough to smoke and have sex!

Viagra doesn’t only help in boosting a man’s performance in the bedroom, but as researchers have also found, it can also help improve heart function.

This finding means that the popular drug prescribed for erectile dysfunction can potentially save the lives of people with specific heart problems.

The study was conducted by researchers at the University of Alberta who are now encouraging doctors to consider prescribing the drug when a patient has a failing right ventricle of the heart, a dire condition for which there are currently no treatments available.

Dr. Jayan Nagendran, a cardiac surgery resident at the U of A and the first author of the paper, said that the finding was important as Viagra can be clinically and immediately relevant to help these patients.

‘There are a number of medical conditions in both children and adults for which there is a need to boost the performance of the right ventricle, and this drug can be clinically and immediately relevant to help these patients,’ he said.

‘Sometimes the right ventricle can fail rapidly and even result in death, like in lung transplant surgery, for example. In such a case, Viagra may increase the right ventricle’s performance and save the patient,’ Dr Nagendran added.

Dr. Evangelos Michelakis, a U of A cardiologist, the Canada Research Chair in Pulmonary Hypertension and the senior author of the paper, said that another reason boffins were thrilled with the results of the study was because whiel there are a number of drugs and therapies available to treat the left ventricle of the heart from failing or afterwards, there are no current treatments for the right ventricle.

‘We have a number of drugs and therapies available to treat the left ventricle of the heart to prevent it from failing or to treat it after it has failed, but we don’t have anything for the right ventricle. The phosphodiesterase type 5 inhibitors, which include Viagra, Cialis and Levitra, may offer some important benefits in this case,’ he said.

In a healthy person, phosphodiesterase type 5 constricts arteries in two places in the body-the lungs and the penis. In the lungs, it prevents excessively low blood pressure. In the penis, it prevents excessive engorgement.

However, undue phosphodiesterase type 5 can constrict these arteries too much and cause problems, as it does in the case of pulmonary hypertension, where lung arteries constrict and put a strain on the right ventricle of the heart.

Phosphodiesterase type 5 inhibitors allow the arteries to relax so that blood can flow more easily.

The researchers studied human hearts and showed that phosphodiesterase type 5 is expressed in large amounts in thickened (hypertrophied) right ventricles, but not in healthy hearts. They replicated their results in animal models and also showed that Viagra enhanced the output of hypertrophied right ventricles.

Michelakis noted that this might be the first example of a drug that can improve the function of the right ventricle (which is diseased in pulmonary hypertension), without affecting the left ventricle (which is normal in pulmonary hypertension).

‘This selectivity is important and has direct clinical implications. Relaxing the lung arteries alone may not be sufficient to help the patient, if the right ventricle is too weak to push blood through them. A drug such as Viagra, with a combined beneficial effect both in the lung arteries and the right ventricle of the heart, offers a significant advantage,’ Michelakis said.

‘Viagra is a drug that millions of people take every year, and we’ve just learned something new and essential about how it works,’ Nagendran said.

‘This drug can have an immediate and direct clinical application, so we’re pretty excited about these findings,’ Michelakis added.

INSIDE his spotless Corstorphine bungalow, 54-year-old Grant Crow answers the phone with a gentle voice as another call comes through from a worried patient who has just been diagnosed with the same life-threatening illness he has - pulmonary hypertension (PH).

In his calm, assured manner, with still a trace of a Canadian lilt to his accent, Grant puts the man at his ease, relieving his worst fears in the way only a fellow sufferer can and promises to send him literature on the rare lung disease - now manageable thanks, in no small part, to Grant’s efforts.

Five years after he was diagnosed with PH, Grant has thrown himself into helping fellow sufferers, spending most of his day staffing the helpline or doing paperwork for PH charity, Pulmonary Hypertension Association UK. For the father-of-three knows he is lucky to still be alive - and he owes it all to Viagra.

Grant became the first person in Europe to go on a revolutionary trial in 2002 to use the celebrated impotence treatment to treat PH, an illness difficult to diagnose and sometimes mistaken for asthma, and from which, without treatment, sufferers are given only two to three years to live. He told doctors at the specialist treatment centre at Glasgow’s Western Infirmary to put him on any trial going after he received the devastating diagnosis, following many tests to find out why he was coughing up “buckets of blood” and getting breathless at the least exertion.

The former restaurant manager, who played semi-professional ice hockey during the 28 years he lived in Canada, told the Evening News in 2005 how being a guinea pig for taking Viagra to treat PH saved his life.

It is now four-and-a-half years since Grant began taking Revatio - a drug with the same active ingredients as Viagra. Since then it has been licensed to treat other patients with PH, including a fellow PH sufferer, who lives just a mile from Grant.

Grant says the innovative treatment has given him a quality of life he couldn’t have expected otherwise. Casually dressed in a sweatshirt, slacks and slippers, surrounded by family photographs in his cheery living room, he says he’s had highs and lows on the pills but, without them, he believes he would be dead.

He says: “When I was diagnosed, without treatment, they gave me 18 months. The only other thing at that point was being fed a drug through a Hickman Line in your chest but they thought oral therapy would give me a better chance of life. Now I pop about a dozen tablets a day and that keeps me going.

“I wouldn’t be here if it wasn’t for the drug, it’s as simple as that.”

PH Awareness Week, which begins on Monday, aims to draw attention to the rare lung disorder in which the blood pressure in the pulmonary artery - which carries blood from the heart to the lungs - rises far above normal levels. The cause is unknown but around 4000 people have been diagnosed as sufferers in the UK and an estimated further 4000 are still undiagnosed.

Grant had to give up his job as a restaurant manager when he was diagnosed because he was ill and to make time for his frequent travel for tests to Glasgow’s Western Infirmary, where they specialise in PH care. Now he spends his days working at home to help the PH charity and walks to the bus stop to collect his nine-year-old daughter Amanda from school, when he feels able.

Some days however, even that is too much of an effort. “Sometimes I walk to the bus stop and have to take a wee stop. I look at the trees and maybe pretend to tie my shoe laces. I have bottles of oxygen I can take through a mask if I get really bad.”

Despite the pills, he had to be hospitalised in October 2005 for around ten days after he began to find himself completely exhausted at even minimal activity, to the point where he woke up one morning and couldn’t get out of bed.

“My wife went behind my back and rang the GP. He came and took one look at me and said he’d call an ambulance, but I have a phobia of ambulances and I said my wife would take me in the car. I was getting severe pains in my chest and I though my day had come.”

Grant was admitted to Edinburgh Royal Infirmary, where he was given lots of oxygen. “They put me on 12 to 14 litres of oxygen a minute in a huge mask. It was like a Force Ten gale blowing in my face.”

The hospital arranged for him to go to Glasgow, where he was treated at Gartnavel Royal Hospital and they put him on Tracleer tablets to bring down his blood pressure by widening the blood vessels, before sending him home.

“I’m on a high level of Revatio, but there’s still room for them to up it. There’s a few side-effects but nothing I can’t live with - your nose constantly runs and I have a lot of gastro-problems, with a burning sensation in my stomach.”

He also has poor circulation and suffers from badly swollen ankles, which look purple-black in colour, though Grant claims they are not painful.

“It’s like someone tying a load of elastic bands around your feet,” he says.

Every three months Grant has to go to Gartnavel, where they do tests, such as putting him on a walking machine for six minutes to check his fitness hasn’t deteriorated. He also gets his Viagra tablets there - he pops 21 pills throughout the day, 12 of which are Revatio - as though the drug is now licensed for PH, he can’t get it from a regular pharmacy.

Grant says it took him a long time to accept his illness and he spent ages racking his brains to think how he got it, or when it first took hold. It was particularly difficult because he was a very active person before, used to working hard and taking the dog for a walk everyday after years of “zooming around the ice”.

With early diagnosis and correct treatment almost two thirds of PH patients will survive longer than five years. But Grant says he takes a day at a time. “I’m a realist now and live for each day.”

PULMONARY hypertension (PH) is a rare lung disorder in which the blood pressure in the pulmonary artery rises far above normal levels. At the same time as the blood pressure rises, the walls of the pulmonary arteries become thicker. What causes the pulmonary arteries to thicken is not known in a lot of cases.

People with PH suffer a variety of debilitating symptoms that result in poor everyday health and quality of life, including breathlessness, dizziness, fainting, chest pains, and lethargy.

Anyone can get PH, although it tends to be more common in women in their 30s and 40s. Many patients are left untreated and for them the disease is potentially life-threatening, with an estimated survival time of less than three years from the time of diagnosis.

The new treatment, Revatio, which has the same essential ingredients as anti-impotence drug Viagra, reduces blood pressure in the pulmonary artery and improves exercise ability for patients. Pfizer undertook a six-year clinical development programme for Revatio because there was evidence that its constituent sildenafil citrate could be an effective treatment in PH.

Warfarin, a drug that stops the blood from clotting, is another drug often prescribed to patients with pulmonary hypertension because they have a tendency to form small blood clots in their lungs.

RICHARD CULLERTON, 43, also from Corstorphine, went to the doctor because he was feeling constantly lethargic and getting severely out of breath every time he walked up a hill.

He had just turned 40 and readily admits that he was unfit and carrying a few extra pounds.

But the dad-of-one, who survived testicular cancer at the age of 22, was really struggling any time he did any physical exercise.

With a heavy heart he went to his doctor - whom he thinks is the one who also treated Grant - who diagnosed him with PH. Richard says: “I was carrying a bit of weight and went for an MOT.

“The GP is a superstar for picking it up.”

The former First ScotRail train driver who now, because of his illness, works for the company in an office role, says it’s been a boost to find a fellow patient so nearby.

“To find out that someone else with PH stays within a mile of the house is unusual. He’s always very upbeat and he’s been able to give me a bit of advice. Also the Pulmonary Vascular Unit in Glasgow is first class,” he says.

The diagnosis was a second blow to the dad-of-one who got testicular cancer just after he got married. However he made a quick recovery from that and hopes he will be as lucky with PH.

“They just took one [testicle] away and sewed me up and sent me away,” he says. “The follow-up is scary though - waiting to see if it will come back.”

Thanks to Grant’s bravery in being part of the pioneering trial in the use of Viagra for PH patients, Richard has been taking the drug since it got its licence.

“I’m on Viagra and it has improved my quality of life.

“I can get along normally and it gives you a lot of pick-me-up.

“I’ve been on it a year since it was licensed and it has stabilised me,” he says.

“That’s a result. Until something else comes on they keep you on it.”

He adds cheekily: “And it puts a smile on my wife’s face.”

Dong-A PharmTech Co., Ltd. announced that it has completed a 340 patient phase 2b “at-home” clinical study for udenafil, its new long acting (12 hour half-life) oral phosphodiesterase type 5 (PDE5) inhibitor for erectile dysfunction (ED). The multi-center study conducted in the U.S. was a randomized, double-blind, placebo controlled study, designed to investigate the efficacy and safety of udenafil in patients with ED. Following a 4-week non-drug baseline period, 340 men with ED of broad etiology and severity were randomized to one of four treatment groups: Placebo, udenafil 50mg, udenafil 100mg or udenafil 150mg. The drug treatment period was 12 weeks with evaluations every 4 weeks. The primary efficacy endpoints were the change in the International Index of Erectile Function (IIEF) Erectile Function Domain (EF) score from baseline to final visit; mean vaginal penetration success rates and mean intercourse completion rates calculated from the Sexual Encounter Profile (SEP) questions 2 and 3, respectively. The study had several secondary efficacy measurements including changes in scores from the other IIEF domains, scores from the remaining SEP questions, changes from baseline in the Patient Self-Assessment Questionnaire (PSAE) and the mean Global Assessment Score (GAQ).

All primary efficacy endpoints were statistically significant compared to placebo. The mean vaginal penetration success rates were 72% (50mg), 88% (100mg) and 82% (150mg) and significantly (p<0.001) higher compared to the 60% observed in the placebo group. The mean intercourse completion rates were 53% (50mg), 66% (100mg) and 69% (150mg) and significantly (p<0.001) higher compared to the 38% observed in the placebo group. Patients reporting improved erections after the 12-week course of therapy were 58% (50mg), 80% (100mg) and 73% (150mg) and significantly (p<0.001) higher compared to 31% in the placebo group. Fifty percent (50%) of the patients in the 150mg group shifted to normal erectile function (EF domain scores >25) after 12 weeks on drug compared to 14% in the placebo group. All three active dose levels were well-tolerated; the most frequently reported adverse events were nasal congestion, flushing and headache and were mostly mild to moderate in intensity. No myalgia, back pain, leg pain or vision disturbances were reported and no serious adverse events related to the drug were reported. Only 4 patients withdrew from the study due to adverse events related to the drug.

Dong-A PharmTech Co., Ltd anticipates that the completion of the phase 2b trial will allow it to proceed with phase 3 clinical trials in the U.S. and Europe.

“We are extremely pleased with the results of this 340 patient phase 2b clinical trial in the U.S. which clearly demonstrated an excellent efficacy and safety profile in erectile dysfunction patients,” stated Dong Hyun Park, President and CEO of Dong-A PharmTech. “The completion of this study is a major milestone in the development of udenafil. We plan to aggressively pursue regulatory approval in major markets throughout the world and to replicate in those markets the commercial success already achieved in Korea.”

Udenafil was approved by the Korean FDA in November 2005 and launched by Dong-A Pharmaceutical in Korea under the brand name Zydena® in late December 2005 as the fourth entrant to the ED market. By the first quarter of 2006, Zydena® garnered 21% market share in Korea in terms of tablet volume and effectively expanded the Korean ED market volume by 16% through the introduction of new patients as well as re-entry of former patients. To date, Zydena® has maintained its market share, surpassing Levitra®, and nearly reaching parity with Cialis® by sales volume.

Dong-A PharmTech Co., Ltd. has initiated the approval process for udenafil in China by filing for import verification. The company is expecting to complete the requirements of the Chinese drug regulatory agency (SFDA), which include a local clinical study, and receive marketing approval in China by 2008.

China’s pharmaceutical market has expanded dramatically in the past decade, and is currently valued at over US$25 billion. It has been reported that as many as 50 percent of Chinese men aged between 40 and 70 are suffering from ED, comparable to other countries. Udenafil is expected to participate in a growing prescription ED market by offering a long-acting and safe product that will compete with Viagra® (Pfizer), Cialis® (Lilly) and Levitra® (Bayer/GSK/Schering-Plough).

Eli Lilly & Co., maker of impotence drug Cialis, hopes that Chinese couples who might resort to traditional aphrodisiacs or divorce court to resolve sexual problems will seek marital bliss with its own remedy.

The U.S. drugmaker launched a marketing campaign for Cialis in the world’s most populous country on Thursday with the release of a survey showing that 45 percent of middle-aged Chinese couples had experienced erectile dysfunction problems.

Since only one-third of those couples had thought about seeking treatment, Lilly believes that efforts to boost awareness of the problem would increase sales of Cialis, whose long-lasting effects have given it the nickname “the weekender.”

“This drug is effective, because men are like light bulbs. They can be turned on and off easily. Women are like irons, they need a long time to heat up, but also a long time to cool down,” said psychologist Qiu Xiaolan, brought in as part of Lilly’s media campaign to educate the public.

Cialis, which has been distributed to 5,000 Chinese pharmacies this month, is effective for up to 36 hours, longer than rival drugs on the market, Lilly says.

“It’s a longer window of opportunity,” Eli Lilly China President Jorg Ostertag told a news briefing.

About 35 million Chinese men suffer from some form of erectile dysfunction, Lilly said. Nearly 10 percent of these will eventually look for some sort of treatment, mainly in pharmacies.

FAMILY HARMONY

Erectile dysfunction is common among men with diabetes, high blood pressure and high cholesterol levels, and has historically been treated in China with traditional medicines containing herbs or animal parts such as tiger penis and rhinoceros horns.

“Erectile dysfunction has become a serious issue. It not only threatens men’s health, but also challenges family relationships and harmony,” Ostertag said.

A local court in south China granted a divorce to a woman who remained a virgin after four years of marriage due to her husband’s apparent sexual dysfunction, Xinhua news agency reported in October.

More than 10 percent of divorce cases center on sexual dysfunction, Xinhua quoted a judge with the court in south China’s Guangxi Zhuang Autonomous Region as saying.

The Supreme People’s Court has ruled that sexual dysfunction that cannot be cured is proper grounds for divorce, Xinhua said.

Industry estimates for China’s market for impotence drugs range from 500 million yuan to as much as 2 billion yuan a year ($65 million to $260 million).

Cialis, although growing faster globally than Viagra, still lags its rival, which was launched in China by Pfizer, the world’s largest drugmaker, in 2000.

Levitra, an impotence drug developed jointly by Bayer AG, GlaxoSmithKline Plc and Schering-Plough Corp., is also available in China.

Pfizer does not disclose sales figures for Viagra in China but global revenues from of the drug rose 1 percent to $1.7 billion last year.

Worldwide sales of Lilly’s Cialis jumped 30 percent to $971 million.

Well… it had to happen. Finally, Viagra will be available over the counter in the UK. Just walk onto Boots the chemist, pay your £50, have a few quick checks… blood pressure etc. Then you get 4 pills. If you want a refill however - you have to do a follow up at the docs. (Or you could of course just go here and buy twice the number of pills of genuine Pfizer Viagra at half the price.)

The impotence drug Viagra will go on sale this week for the first time without prescription at three branches of a high street chemist.

Boots’s decision to sell the drug over the counter from Wednesday at three of its stores in Manchester coincides with Valentine’s Day and National Impotence Day. If the pilot scheme is successful, it will be extended to branches throughout Britain.

Customers will have to reveal their medical history to a pharmacist, and have their blood pressure, cholesterol and glucose levels tested, before they can purchase the packet of four diamond-shaped blue tablets for £50.

Viagra available on high street without prescription in trial run

The impotence drug Viagra will go on sale this week for the first time without prescription at three branches of a high street chemist.

Boots’s decision to sell the drug over the counter from Wednesday at three of its stores in Manchester coincides with Valentine’s Day and National Impotence Day. If the pilot scheme is successful, it will be extended to branches throughout Britain.

Customers will have to reveal their medical history to a pharmacist, and have their blood pressure, cholesterol and glucose levels tested, before they can purchase the packet of four diamond-shaped blue tablets for £50.

Until now, men wishing to take Viagra have been able to obtain it on prescription by appointment with a GP. Others use the less reliable method of obtaining the drug over the internet.

The drug will be available to men aged between 30 and 65. Boots claims that only 10% of the estimated 3 million men in Britain who suffer from impotence are being treated.

The drug works by relaxing the blood vessels and increasing the blood flow to the penis, helping users to overcome erectile dysfunction for around four hours. Boots already sells weight-loss drugs and treatments for balding under the same arrangement - known as a patient group direction.

Men will be asked to have a consultation with a private doctor, at a further cost of £37.50, if they wish to buy regular supplies of Viagra. If given the all-clear, they will be able to buy packs of four tablets for £21.25, which is comparable with prices on the internet.

A Boots spokeswoman said: “There are a number of safety checks in place to ensure correct supply. People will have to go through a thorough consultation with a pharmacist. They would then need to see a doctor to have a full medical examination before getting an ongoing supply.

“Erectile dysfunction can be a marker for an underlying medical condition and so we are keen to take this extra step.”

It is estimated that Viagra, manufactured by Pfizer, is taken by 27 million men worldwide, including around 900,000 in Britain. Viagra has faced strong competition from rival drugs such Cialis, manufactured by Eli Lilly, which can work for 36 hours.

A study published in today’s issue of the American Journal of Medicine calculates that more than 18 million American men over age 20 are affected by erectile dysfunction, the inability to maintain or achieve an erection.
Almost 90 percent of the studied men with dysfunction had at least one risk factor for heart disease, such as diabetes, hypertension, poor cholesterol levels or smoking. They also were less likely to have had strenuous exercise within the month prior to the study.
With such a strong link between sexual problems and lifestyle, health providers are hoping men will make changes.
“This may be a powerful motivator for male patients who may be at risk for cardiovascular disease or who have diabetes,” said Elizabeth Selvin, lead author and a faculty member in the Johns Hopkins Bloomberg School of Public Health’s Department of Epidemiology. “It’s another reason to get off the couch and exercise and eat well.”
Researchers culled data from 2,126 participants in the National Health and Nutrition Examination Survey. Men who reported being “sometimes able” or “never able” to get and keep an erection were labeled as having erectile dysfunction, while men who reported being “always or almost always able” or “usually able” were not.
The prevalence of erectile dysfunction was 18 percent. Men 70 and older were more likely to suffer from erectile dysfunction, compared to 5 percent of men between ages 20 and 40.
Almost half of all men in the study with diabetes also had erectile dysfunction.
Steven N. Gange, a urologist at Western Urological Clinic in Salt Lake City, said he believes from other studies that the number of men with the condition is much higher.
“This is actually a much lower number than I’m comfortable with,” Gange said.
The diabetes findings make sense to him. “Diabetes ultimately does become a vascular disease, and smoking and aging are also risk factors,” he said.
Erectile dysfunction can be the first sign of a vascular disease in otherwise seemingly healthy males. Recently, Gange saw a 33-year-old smoker who wasn’t responding to Viagra, Cialis or Levitra, popular drug treatments that increase blood flow to the penis. Gange recommended he see a cardiologist.
Blake Hamilton, a urologist with University Health Care in Salt Lake City, said men may seek medical help for sexual problems before other health issues because it affects their lives so negatively.
“Men often put things off,” he said. “But a lot will go to the doctor for erectile dysfunction. It’s important to make the connection between” erectile dysfunction and cardiovascular disease.
Brent Muhlestein, director of cardiology research at LDS Hospital in Salt Lake City, says cardiologists should ask their patients about erectile dysfunction.
They also need to be very careful when prescribing the three treatment drugs, because they can be dangerous for patients on nitroglycerin. Since both types of drugs can cause blood pressure to drop, when coupled, they can lead to plummeting blood pressure, heart attacks and even death.
“We have to learn when it’s safe and not safe to let patients with heart disease use Viagra or other similar medications,” Muhlestein said. “A lot of men ask for it because it’s very distressing to them.”
He also thinks more men might be willing to become healthier if they understand all the ways it can improve their lives.
“One thing I have done is tell patients not only can you prevent yourself from having a heart attack or stroke in the future, but it will also probably help your sex life to last longer,” he said. “Sometimes that catches their attention.”

If you’ve ever watched a prime-time television show, you’ve seen the ads for Viagra, Levitra or Cialis, drugs that treat erectile dysfunction drugs.

Those medications have helped millions of men have a normal sex life.

“Patients are able to converse much more freely amongst their friends, amongst their partners,” said Dr. Ajay Nehra of the Mayo Clinic.

Talking to a doctor about erectile dysfunction, or E.D., is the first step toward being treated successfully with the popular drugs.

“Erectile dysfunction is really synonymous with what we call endothelial dysfunction,” Nehra said.

Endothelial dysfunction is when the inner lining of the blood vessels don’t function properly, which means blood doesn’t flow as it should. It can be a complication of many issues including heart disease, diabetes, high blood pressure, prostate surgery or alcoholism.

Viagra, which has been on the market the longest, is fast-acting. It starts working within 1 to 2 hours and lasts from 6 to 12 hours.

Levitra is similar but it’s even faster. It works within 30 minutes and lasts 6 to 12 hours.

Cialis is a little different. It takes 3 to 4 hours to work and it lasts for 2 to 3 days.

All three drugs are safe for most men, but they can cause side effects including headache, stomachache and flushing. Cialis can also cause back or leg pain. So, the drug you choose depends on your lifestyle and your health.

E.D. drugs are effective for 50 to 60 percent of men who take them. Be sure you tell your doctors about any other medications you’re on before your prescribed any of these medicines.

Best way forward - try an ED starter pack and find out what works best for you!

Sales and profit of Cialis continued to show healthy gains in the fourth quarter, underscoring why Eli Lilly and Co. wants to buy out its longtime partner in the blockbuster product.

Fourth-quarter profit increased 63 percent, to $99.9 million, Lilly and its partner, Icos Corp. of Bothell, Wash., said Thursday after the markets closed.
The increase, in line with earlier guidance, was due, in part, to strong sales and lower marketing expenses. Fourth-quarter sales rose 28 percent from a year ago to $269.2 million. Cialis is the world’s No. 2 selling drug for erectile dysfunction, behind Pfizer’s Viagra.
Icos shareholders will vote on Lilly’s acquisition offer Thursday. Lilly is offering to pay $2.28 billion, or $34 a share, a price that one large Icos shareholder, New York hedge fund HealthCor Management, has criticized as too low, given the drug’s robust growth.
For the full year, the joint venture earned $320 million on sales of $971 million.
Lilly originally offered $32 a share in October, but raised the price by $2 a share, or 6.3 percent, after the bid came under attack.
Indianapolis-based Lilly and Icos market the drug in North America and Europe through a partnership. If Icos shareholders approve the deal, Lilly will get all the revenue. Most of Icos’ 700 employees are likely to lose their jobs after the sale is closed.