If a patient exhibits >3 but ≤5 x the upper limit of normal (ULN) ALT and/or AST with- out symptoms or hyperbilirubinemia after starting pirfenidone tablets therapy: • Discontinue confounding medications, ex- clude other causes, and monitor the pa- tient closely.
The district court began its analysis by noting that the parties “agree that Sandoz’s label recommends using pirfenidone for the treatment of IPF and includes treat- ment instructions for patients exhibiting Grade 2 eleva- tions in ALT and/or AST.” Decision at *7.
Lastly, Genentech asserts that objective indicia of nonobvi- ousness weighed in its favor because it showed skepticism regarding pirfenidone’s efficacy and safety, as well as evi- dence of a long-felt and unmet need of treating patients fol- lowing Grade 2 AST/ALT elevations.
In Eli Lilly, for ex- ample, we relied on “[t]he product labeling, combined with [] testimony [discussing physicians’ general practices]” to conclude that there was sufficient evidence “that physi- cians condition ... treatment on” the patients’ perfor- mance of the patented method, thereby satisfying the GENENTECH, INC. v. SANDOZ INC. requirements for proving direct infringement.
Weighing all the evidence, the district court did not clearly err in finding that Genentech had not met its bur- den to show that if Sandoz’s drug were put on the market, it would directly infringe the asserted claims of the DDI patents which require use of both pirfenidone and fluvox- amine.