Meeting the obesity challenge: New drugs, market trends and future developments

Meeting the obesity challenge: New drugs, market trends and future developments

More than 15% of the European population and 30% of the US population are currently obese. Furthermore, it is estimated that global obesity related problems account for up to 10% of total healthcare budgets. Yet, until recently medical treatments for obesity were limited and had harmful side effects.

Radical market changes

Two radical new products which are safe and effective have turned the obesity market on its head. Knoll's sibutramine and Roche's orlistat are positioned to become best sellers - in fact both drugs are expected to achieve sales of more that $1 billion by the end of 2000. The market has been transformed into a multi billion dollar industry, offering tremendous rewards for all involved.

An authoritative and comprehensive evaluation

Meeting the obesity challenge: New drugs, market trends and future developments from Scrip Reports discusses these new developments in detail, enabling you to take maximum advantage of the opportunities presented.

In addition to providing essential background details, this report shows the current market status geographically and discusses market growth for the major continents of the world. The result of extensive research, Meeting the obesity challenge assesses all the major obesity treatments that are currently available, focusing specifically on the new blockbuster drugs. Their market penetration is discussed and forecasts to 2003 are provided.

Price: £495/$1,040/¥119,000
Pages: 150+
Published: June 1999
Ref: BS1013E

CONTENTS
LIST OF TABLES
LIST OF FIGURES
EXECUTIVE SUMMARY
ABBREVIATIONS
SCOPE AND METHODOLOGY

S.1 Background
S.2 Objectives of the report
S.3 Methodology
S.4 Report structure
S.5 Boundaries of the report
S.6 Exchange rates

CHAPTER 1 OBESITY: THE DISEASE
1.1 Overview
1.2 Obesity: a heterogeneous disease
1.2.1 World Health Organization definition
1.2.1.1 Types of obesity
1.2.2 Measuring obesity
1.2.2.1 Body mass index
1.2.2.2 Waist-to-hip ratio and waist circumference
1.2.2.3 Other assessment tools
1.3 Aetiology of obesity
1.3.1 Age and gender
1.3.2 Pathophysiology of obesity
1.3.2.1 Neurology and endocrinology
1.3.2.2 Genetics
1.3.2.3 Metabolism
1.3.2.4 Biochemistry
1.3.2.5 Nutrition
1.3.2.6 Physical activity
1.3.2.7 Viral infection and obesity
1.3.3 Non-physiological determinants of obesity
1.3.3.1 Psychosocial factors
1.3.3.2 Environmental and sociocultural factors
1.4 Points of intervention
1.4.1 Medical therapy
1.4.1.1 Potential targets
1.4.2 Bariatric surgery
1.4.3 Psychological intervention
1.5 Health risks associated with obesity
1.5.1 Cardiovascular disease
1.5.1.1 Hypertension
1.5.1.2 Stroke
1.5.1.3 Dyslipidaemia
1.5.1.4 Cardiomyopathy
1.5.2 Non-insulin dependent diabetes mellitus
1.5.2.1 Insulin resistance
1.5.3 Respiratory disease
1.5.4 Gallbladder disease
1.5.5 Cancer
1.5.5.1 Endometrial cancer
1.5.5.2 Breast cancer
1.5.5.3 Prostate cancer
1.5.5.4 Colon cancer
1.5.6 Osteoarthritis
1.5.7 Reproductive dysfunction
1.5.8 Other obesity-related co-morbidities

CHAPTER 2 GLOBAL ISSUES
2.1 Overview
2.2 Epidemiology
2.2.1 Global demographic data
2.2.1.1 The WHO MONICA study
2.2.1.2 Prevalence rates
2.2.1.3 WHO mortality statistics
2.2.2 Childhood obesity epidemic
2.2.2.1 Prevalence of childhood obesity
2.2.2.2 Childhood obesity and the future
2.3 Economic burden
2.3.1 Obesity healthcare costs in the US
2.3.1.1 Other costs
2.3.2 Obesity healthcare costs in the UK
2.3.3 Obesity healthcare costs in France
2.3.4 Obesity healthcare costs in the Netherlands
2.3.5 Obesity healthcare costs in Germany
2.3.6 Obesity healthcare costs in Australia
2.3.7 Obesity healthcare costs in New Zealand
2.4 The obesity market
2.4.1 Potential growth
2.4.1.1 Europe
2.4.1.2 North America
2.4.1.3 Asia
2.5 Prevention
2.5.1 WHO International Obesity Task Force
2.5.2 US National Institute of Diabetes and Digestive and Kidney Diseases
2.5.3 Department of Health
2.5.3.1 UK Department of Health
2.5.4 Centers for Disease Control and Prevention
2.5.4.1 Healthy People 2000 and Healthy People 2010
2.5.5 North American Association for the Study of Obesity
2.5.6 International Association for the Study of Obesity
2.5.7 The European Association for the Study of Obesity
2.5.8 Eurobesitas
2.5.9 The American Association of Clinical Endocrinologists and the American College of Endocrinology
2.5.10 The Royal College of Physicians
2.5.11 American Society of Bariatric Physicians
2.5.12 American Society for Bariatric Surgery
2.5.13 International Federation for the Surgery of Obesity

CHAPTER 3 TREATMENTS FOR OBESITY
3.1 Overview
3.2 Pharmacotherapy
3.2.1 Short-term therapies
3.2.1.1 Sympathomimetic drugs
3.2.1.2 Amphetamines
3.2.1.3 Diethylpropion
3.2.1.4 Mazindol
3.2.1.5 Phentermine
3.2.1.6 Fenfluramine and dexfenfluramine
3.2.2 Long-term anti-obesity agents
3.2.2.1 Sibutramine
3.2.2.2 Orlistat
3.2.3 Other pharmacotherapies
3.2.3.1 Fluoxetine
3.2.3.2 Sertraline
3.2.4 Over-the-counter anti-obesity agents
3.2.4.1 Phenylpropanolamine
3.2.4.2 Ephedrine and xanthine derivatives
3.2.4.3 Nutrition supplements, dietary aids and very low calorie diets
3.2.4.4 Fat substitutes
3.2.4.5 Bulking agents
3.2.4.6 Chromium
3.2.4.7 Novel over-the-counter treatments
3.3 Surgical intervention
3.3.1 Vertical banded gastroplasty and gastric banding
3.3.1.1 The Lap Band
3.3.2 Gastric bypass
3.4 Behavioural intervention
3.5 Medical management

CHAPTER 4 NEW ANTI-OBESITY AGENTS - SIBUTRAMINE AND ORLISTAT
4.1 Overview
4.2 Sibutramine
4.2.1 Pharmacology and pharmacokinetics
4.2.1.1 Absorption
4.2.1.2 Distribution
4.2.1.3 Metabolism
4.2.1.4 Excretion
4.2.2 Indications and dosage
4.2.3 Efficacy and safety
4.2.3.1 Contraindications
4.2.3.2 Adverse reactions
4.2.4 Clinical studies
4.2.5 Market penetration
4.2.5.1 Worldwide sales
4.2.5.2 Worldwide market share
4.2.5.3 Competition
4.2.5.4 Marketing campaign
4.2.5.5 Agreements
4.2.6 Future developments
4.2.6.1 Tularik collaboration
4.2.6.2 Knoll as a pharmaceutical specialist
4.2.6.3 Sibutramine and depression
4.3 Orlistat
4.3.1 Pharmacology and pharmacokinetics
4.3.1.1 Absorption
4.3.1.2 Distribution
4.3.1.3 Metabolism
4.3.1.4 Excretion
4.3.2 Indications and dosage
4.3.3 Efficacy and safety
4.3.3.1 Orlistat and breast cancer
4.3.3.2 Contraindications
4.3.3.3 Adverse reactions
4.3.4 Clinical studies
4.3.5 Market penetration
4.3.5.1 Worldwide sales
4.3.5.2 Worldwide market share
4.3.5.3 Competition
4.3.5.4 Marketing campaign
4.3.5.5 Agreements
4.3.6 Future developments
4.3.6.1 Millennium Pharmaceuticals collaboration
4.3.6.2 Nutritional research

CHAPTER 5 DRUGS IN DEVELOPMENT
5.1 Overview
5.2 Novel molecular targets
5.2.1 Agouti-related protein antagonists
5.2.1.1 Gryphon Sciences
5.2.1.2 Amgen
5.2.2 Amylase inhibitors
5.2.2.1 Alizyme
5.2.3 (3-adrenoceptor agonists
5.2.3.1 Merck & Co
5.2.3.2 SmithKline Beecham
5.2.3.3 Dainippon
5.2.3.4 Eli Lilly
5.2.3.5 Bristol-Myers Squibb
5.2.3.6 Sanofi
5.2.3.7 Boehringer Ingelheim and Pfizer
5.2.3.8 Fujisawa
5.2.4 Cocaine and amphetamine related transcript agonists
5.2.5 Cholecystokinin
5.2.5.1 Warner-Lambert
5.2.5.2 Glaxo Wellcome
5.2.5.3 Bioprojet
5.2.6 Complement factors
5.2.6.1 ObeSys
5.2.7 Corticotrophin releasing factor/urocortin
5.2.8 Dopamine agonists
5.2.8.1 Neuromedica
5.2.8.2 Ergo Science
5.2.9 Galanin receptor antagonists
5.2.9.1 Schering-Plough
5.2.10 Glucagon-like peptide-1
5.2.10.1 Amylin
5.2.10.2 Modex Therapeutics
5.2.11 Growth hormone/growth hormone releasing hormone
5.2.11.1 Tulane University
5.2.11.2 Merck & Co
5.2.12 Histamine antagonists
5.2.12.1 Gliatech
5.2.13 Leptin
5.2.13.1 Amgen
5.2.13.2 Eli Lilly
5.2.13.3 Amylin
5.2.13.4 Ligand and SmithKline Beecham
5.2.13.5 Cambridge Antibody Technology
5.2.14 Lipase inhibitors
5.2.14.1 Alizyme Therapeutics
5.2.14.2 GelTex Pharmaceuticals
5.2.15 Melanocortin receptor agonists
5.2.15.1 Trega
5.2.15.2 Trega and Novartis
5.2.16 Melanocyte stimulating hormone antagonists
5.2.16.1 Gryphon Sciences
5.2.17 Mitochondrial electron transporters/uncoupling proteins
5.2.17.1 Amylin
5.2.18 Nerve growth factor
5.2.18.1 Regeneron, Procter & Gamble and Medtronic
5.2.18.2 Sigma-Tau
5.2.19 Neuropeptide Y antagonists
5.2.19.1 Novartis
5.2.19.2 Sanofi
5.2.19.3 Agouron
5.2.19.4 Bayer
5.2.19.5 Pfizer and Neurogen
5.2.20 Nicotinic metabolites
5.2.20.1 LecTec
5.2.20.2 Autogen
5.2.21 Opioid receptor antagonists
5.2.21.1 HG Pars
5.2.22 Peroxisome proliferator-activated receptor agonists
5.2.22.1 Nippon Chemiphar
5.2.22.2 Glaxo Wellcome
5.2.23 Retinoid X receptor (rexinoids) agonists
5.2.23.1 Ligand
5.2.24 Serotonin reuptake inhibitors
5.2.24.1 Pfizer
5.2.24.2 Cerebrus
5.2.24.3 Sepracor
5.2.25 Thyroid hormone ligands
5.2.25.1 Bristol-Myers Squibb and Karo Bio
5.2.26 Tumour necrosis factor-(
5.2.26.1 Celgene
5.2.27 Tyrosine phosphatase inhibitors
5.2.27.1 Novo Nordisk
5.2.28 Phytopharm and P57
5.2.29 Chromium
5.3 Collaborative research and development
5.3.1 Millennium Pharmaceuticals
5.3.1.1 Millennium Pharmaceuticals and Roche
5.3.1.2 Millennium Pharmaceuticals and Bayer
5.3.2 AxyS and Glaxo Wellcome
5.3.3 Alizyme
5.3.3.1 Alizyme and Yakurigaaku Chou Kenyusho
5.3.3.2 Alizyme and the Institute of Food and Drug Research
5.3.3.3 Alizyme and Oxford Molecular Group
5.3.3.4 Alizyme and Peptide Therapeutics
5.3.4 Sequana Therapeutics and the Institut Pasteur
5.3.5 Eisai and Knoll
5.3.6 Knoll and Tularik
5.3.7 Bayer and Myriad
5.3.8 Neurogen and Pfizer
5.3.9 SmithKline Beecham and Ligand Pharmaceuticals
5.3.10 Eli Lilly, Columbia University, Institut de Biologie de Lille and Wellcome Trust Centre for Human Genetics
5.3.11 Lipha and Autogen
5.3.12 Bristol-Myers Squibb and Karo Bio
5.3.13 Regeneron, Procter & Gamble and Medtronic
5.3.14 Amgen and the Rockefeller University
5.3.15 ObeSys and Cambridge Antibody Technology
5.3.16 Eli Lilly and Allelix
5.3.17 Tularik and Japan Tobacco
5.3.18 Northwest Neurologic and Trega Biosciences
5.3.19 Ligand and Eli Lilly
5.3.20 Ligand and SmithKline Beecham
5.3.21 Ergo Science and Johnson & Johnson
5.3.22 Amylin and ChemDiv
5.3.23 Trega and Novartis
5.3.24 Chiroscience and Gemini Research
5.3.25 Exelixis Pharmaceuticals and Pharmacia & Upjohn
5.4 Drugs withdrawn from development

CHAPTER 6 COMPANY PROFILES
6.1 Overview
6.2 Alizyme
6.2.1 Anti-obesity product agreements
6.2.2 Financial figures
6.2.3 Anti-obesity products in development
6.3 Amgen
6.3.1 Anti-obesity product agreements
6.3.2 Financial figures
6.3.3 Best sellers
6.3.4 Anti-obesity products in development
6.4 Bayer
6.4.1 Anti-obesity product agreements
6.4.2 Financial figures
6.4.3 Best sellers
6.4.4 Anti-obesity products in development
6.5 Bristol-Myers Squibb
6.5.1 Anti-obesity product agreements
6.5.2 Financial figures
6.5.3 Best sellers
6.5.4 Anti-obesity products in development
6.6 Eli Lilly
6.6.1 Anti-obesity product agreements
6.6.2 Financial figures
6.6.3 Best sellers
6.6.4 Anti-obesity products in development
6.7 Knoll
6.7.1 Anti-obesity product agreements
6.7.2 Financial figures
6.7.3 Best sellers
6.7.4 Anti-obesity products in development
6.8 Pfizer
6.8.1 Anti-obesity product agreements
6.8.2 Financial figures
6.8.3 Best sellers
6.8.4 Anti-obesity products in development
6.9 Phytopharm
6.9.1 Anti-obesity product agreements
6.9.2 Financial figures
6.9.3 Anti-obesity products in development
6.10 Roche
6.10.1 Anti-obesity product agreements
6.10.2 Financial figures
6.10.3 Best sellers
6.10.4 Anti-obesity products in development
6.11 Warner-Lambert
6.11.1 Anti-obesity product agreements
6.11.2 Financial figures
6.11.3 Best sellers
6.11.4 Anti-obesity products in development

REFERENCES AND FURTHER READING

APPENDIX I ANTI-OBESITY DRUGS CURRENTLY IN DEVELOPMENT
APPENDIX II ASSOCIATIONS AND INFORMATION SITES
APPENDIX III COMPANY ADDRESSES

LIST OF TABLES
Table 1.1 Standard table of BMI
Table 1.2 WHO classification of weight in adults according to BMI
Table 1.3 Advanced assessment tools for measuring obesity
Table 1.4 Neurological and endocrinological disorders associated with obesity
Table 1.5 Genetic models of obesity in mice
Table 1.6 Peptides associated with food intake and body weight regulation
Table 1.7 Potential molecular targets for new anti-obesity drugs
Table 1.8 Hormones, paracrine factors and other agents that affect the replication and differentiation of human or rodent preadipocytes
Table 1.9 Co-morbidities associated with obesity
Table 2.1 Prevalence rates of obesity in some European countries
Table 2.2 Obesity prevalence (BMI(30kg/m2) in selected countries of the Americas
Table 2.3 Obesity prevalence (BMI(30kg/m2) in selected countries in Africa
Table 2.4 Obesity prevalence (BMI(30kg/m2) in selected Western Pacific countries
Table 2.5 WHO morbidity rates for the 10 leading causes of death, 1997
Table 2.6 Annual direct and indirect costs of disease attributable to obesity in the US, 1995
Table 2.7 Additional healthcare costs associated with health risks for severely overweight women (BMI(29kg/m2) over 25 years
Table 2.8 High-risk groups targeted for the prevention of obesity
Table 3.1 Current anti-obesity pharmacotherapies
Table 4.1 Placebo-controlled studies of sibutramine showing mean dose-dependent weight loss
Table 4.2 Contraindications for sibutramine therapy
Table 4.3 Drugs that interact with sibutramine
Table 4.4 Adverse reactions associated with sibutramine therapy
Table 4.5 Worldwide sales forecasts for sibutramine ($ million), 1998-2003
Table 4.6 World market share of sibutramine compared with other anti-obesity drugs in 1998
Table 4.7 Worldwide market share forecast of sibutramine compared with other anti-obesity drugs, 1999
Table 4.8 Worldwide market share forecast of sibutramine compared with other anti-obesity drugs, 2000
Table 4.9 Worldwide market share forecast of sibutramine compared with other anti-obesity drugs, 2003
Table 4.10 Placebo-controlled studies of orlistat
Table 4.11 Contraindications for orlistat therapy
Table 4.12 Drugs that interact with orlistat
Table 4.13 Adverse gastrointestinal events associated with 1 year of treatment with orlistat
Table 4.14 General adverse events with orlistat therapy
Table 4.15 Worldwide sales forecasts for orlistat ($ million), 1998-2003
Table 4.16 Worldwide market share of orlistat compared with other anti-obesity drugs in 1998
Table 4.17 Worldwide market share forecast of orlistat compared with other anti-obesity drugs, 1999
Table 4.18 Worldwide market share forecast of orlistat compared with other anti-obesity drugs, 2000
Table 4.19 Worldwide market share forecast of orlistat compared with other anti-obesity drugs, 2003
Table 5.1 Potential anti-obesity agents currently in R&D
Table 6.1 Alizyme's financial figures ($ thousand), 1996-1998
Table 6.2 Amgen's financial figures ($ million), 1995-1998
Table 6.3 Bayer's financial figures ($ million), 1995-1998
Table 6.4 Bayer's sales by region ($ million), 1997-1998
Table 6.5 Bayer's sales by division ($ million), 1997-1998
Table 6.6 Bristol-Myers Squibb's financial figures ($ million), 1995-1998
Table 6.7 Bristol-Myers Squibb's sales by business segment ($ million), 1996-1998
Table 6.8 Bristol-Myers Squibb's sales by geographical area ($ million), 1996-1998
Table 6.9 Eli Lilly's financial figures ($ million), 1995-1998
Table 6.10 Eli Lilly's sales by business segment ($ million), 1996-1998
Table 6.11 Eli Lilly's sales by geographical area ($ million), 1996-1998
Table 6.12 BASF's financial figures ($ million), 1996-1998
Table 6.13 BASF's business segment sales ($ million), 1997-1998
Table 6.14 BASF's sales by region ($ million), 1997-1998
Table 6.15 Pfizer's financial figures ($ million), 1995-1998
Table 6.16 Pfizer's net sales by business segment ($ million), 1996-1998
Table 6.17 Pfizer's net sales by geographical area ($ million), 1996-1998
Table 6.18 Phytopharm's financial figures ($ thousand), 1997-1998
Table 6.19 Roche's half-year financial figures ($ million), 1997-1998
Table 6.20 Roche's half-year sales by business segment ($ million), 1997-1998
Table 6.21 Warner-Lambert's financial figures ($ million), 1995-1998
Table 6.22 Warner-Lambert's sales by business segment ($ million), 1996-1998
Table 6.23 Warner-Lambert's sales by geographical area ($ million), 1996-1998

LIST OF FIGURES
Figure 1.1 Diagrammatic representation of factors associated with the aetiology of obesity
Figure 2.1 BMI distribution: age standardised proportions of selected categories in MONICA populations, age group 35-64 years (men)
Figure 2.2 BMI distribution: age standardised proportions of selected categories in MONICA populations, age group 35-64 years (women)
Figure 4.1 Mechanism of action of sibutramine
Figure 4.2 Mean dose-dependant weight reduction with sibutramine treatment
Figure 4.3 Inhibition of pancreatic lipase by orlistat
Figure 4.4 Mean weight reduction with orlistat therapy

EXECUTIVE SUMMARY
Obesity is a chronic condition that develops when energy intake exceeds energy expenditure, resulting in excessive body weight. Medical opinions concerning obesity have universally shifted in recent years: in the past it was thought to be a 'lifestyle' disorder - a result of overeating and laziness; today, medical experts recognise obesity to be medical disease that manifests serious co-morbidities if left untreated.

Although the true cause remains unclear, medical and scientific evidence suggests that obesity results from dysfunctional biological mediators of weight regulation, a genetic predisposition to fatness, ageing, sociocultural and/or environmental influences, and the more commonly accepted notion of excessive dietary fat intake and low levels of physical activity, commensurate with affluent industrialised lifestyles.

Regardless of aetiological standpoint, obesity is increasing in many countries and contributes a significant burden to healthcare costs of nations worldwide. In Europe, more than 15% of the population are obese and in the US this figure doubles to more than 30%. The International Obesity Task Force in collaboration with the World Health Organization estimates that there are more than 250 million obese people around the world today, which they predict will rise dramatically in both developed and non-developed countries in the next century. Economic analysts indicate that the global direct and indirect costs of obesity range from 4-10% of total healthcare budgets. In the US alone, direct obesity costs have reached more than $68 million, taking 6% of the total US healthcare expenditures (Wolf, 1998).

Medical treatments for obesity have so far been limited. Harmful side effects and adverse reactions led to the withdrawal of previous prescription-only anti-obesity treatments. Two new products, sibutramine and orlistat, have hit the market and are positioned to become best sellers for their manufacturers, Knoll and Roche, respectively. They have been approved worldwide since 1997 and sales have exceeded company predictions. Both drugs are expected to achieve sales of more than $1 billion by the end of 2000. Since their launch, major biotechnology and pharmaceutical companies have intensified their research efforts to hasten the discovery and development of anti-obesity agents. Today, the search for efficacious long-term and tolerable anti-obesity agents has transformed the field of obesity research into a multibillion-dollar industry.

Guidelines and preventive measures have been produced by leading obesity experts to help healthcare professionals educate and inform people about the disorder, consequential health risks and treatment options. General public awareness campaigns have been lacking and only select high-risk groups have so far been the focus of prevention campaigns. Governments and media groups have shown limited interest in obesity as a major health problem. Additionally, medical scientists warn of a childhood and adolescent obesity pandemic, which will not only add to the existing socioeconomic burden of the illness but will present a significant challenge to health services in diagnosis, treatment and management of this subset of the population.

The aims of this report are to inform the reader of the characteristics, aetiology, epidemiology and pathophysiology of obesity; to provide a comprehensive review of current and future anti-obesity treatments; to highlight the global issues surrounding the disorder with a view to prevention and medical management; and to provide an up-to-date account of the global obesity market with future market projections.

The Scope and Methodology section introduces the reader to the background of obesity as a medical condition and explains the objectives and boundaries of this report in addition to its scope and structure.

Chapter 1 provides general details on the definition, measurement, aetiology and pathophysiology of obesity. It explains that obesity occurs as a result of various physiological, genetic, environmental, sociocultural and behavioural abnormalities, which together or independently contribute to a long-term chronic disease, often with serious health consequences, including cardiovascular disease, non-insulin dependent diabetes mellitus, dyslipidaemia and gallstones.

The chapter also provides an account of the intervention points for various therapies. Potential molecular targets that have been identified in the processes of food intake and regulation are possible anti-obesity drug targets; in addition, surgical and psychological interventions help to manage and control the progression of the disorder.

Chapter 2 describes the global issues to which obesity is associated. Epidemiological and demographic data show that adult obesity prevalence rates are increasing worldwide and highlight the childhood and adolescent obesity epidemic which is on the horizon for the 21st century. The current state of the obesity market is represented geographically and market growth for the major continents of the world is shown.

Comparative economic healthcare costs of obesity are also detailed in this chapter which indicate burgeoning demands on healthcare resources as a result of the increasing incidence of obesity in the US, Europe and parts of Asia.

Preventive guidelines are discussed in relation to the efforts of governments, academic institutions and obesity societies.

Current treatments for obesity are presented in Chapter 3. Short and long-term agents, over-the-counter preparations and other pharmacotherapies are discussed in addition to surgical and psychological interventions. The advantages and disadvantages of each mode of treatment are covered and a medical management section provides guidance for treatment.

Chapter 4 comprehensively addresses the new long-term anti-obesity drugs, sibutramine and orlistat. This chapter reports on the pharmacology, efficacy, clinical trials and safety profiles of each drug. It also investigates the market penetration for the drugs and provides sales forecasts to 2003. Future developments of the manufacturers are also discussed to elucidate possible business interests and development opportunities.

Drugs in development are featured in Chapter 5. More than 25 compounds are in research and development programmes of 50 or more biotechnology and pharmaceutical companies. Research interests are diverse but efforts appear to be focused on (3-adrenoceptor agonists, leptin, and neuropeptide Y antagonists. Development of novel organic compounds like Phytopharm's P57 and Alizyme's natural lipase inhibitors have also received newsworthy attention over recent months.

This chapter also lists current anti-obesity drug research collaborations. Twenty-four research agreements are documented in this chapter.

Chapter 6 provides information on pharmaceutical companies that are currently developing anti-obesity therapies. Many are collaborating with biotechnology or human genome research institutions to discover and develop valuable treatments for the future.