Semaglutide is already prescribed on the NHS for the treatment of diabetes, however GPs have been advised not to start giving the drug to new patients since last year, due to a global supply shortage caused by the unauthorized prescription for weight loss.
In March, NICE for the first time recommended the use of semaglutide as part of a patient’s obesity treatment, in a specialist NHS weight management service and supported by a multidisciplinary team.
More recently, he proposed that four digital apps could be used to help manage weight and even prescribe weight-loss medications.
NICE has said semaglutide should be prescribed to adults who have at least one weight-related comorbidity and a BMI of at least 35kg/m2, along with a low-calorie diet and increased physical activity.
1 Recommendations
1.1 Semaglutide is recommended as an option for weight management, including weight loss and maintenance, along with a low-calorie diet and increased physical activity in adults, only if :
- It is used for up to 2 years and within a specialist weight management service that provides multidisciplinary management of overweight or obesity (including but not limited to levels 3 and 4).
- Have at least 1 weight-related comorbidity and:
- a body mass index (BMI) of at least 35.0 kg/m2, or
- a BMI of 30.0 kg/m2 to 34.9 kg/m2 and meet the criteria for referral to specialist weight management services in the NICE guideline on obesity: identification, assessment and management.
- Use lower BMI thresholds (generally reduced by 25 kg/m2) for people of South Asian, Chinese, Other Asian, Middle Eastern, Black African or Afro-Caribbean family origins.
1.2 Consider discontinuing semaglutide if less than 5% of initial weight has been lost after 6 months of treatment.
1.3 These recommendations are not intended to affect semaglutide treatment that was started in the NHS before this guidance was published. People receiving treatment outside these recommendations can continue without changes to the funding arrangements in place for them before this guidance was published, until they and their NHS doctor consider it appropriate to stop.
Why did the committee make these recommendations?
Management of overweight and obesity in adults includes lifestyle measures alone or with orlistat, or referral to specialist weight management services (such as level 3 or 4), which may include liraglutide or bariatric surgery.
Evidence from clinical trials shows that:
- People lose more weight with semaglutide along with supervised weight management support than with support alone.
- More weight is lost with semaglutide than with liraglutide.
- In people with nondiabetic hyperglycemia , semaglutide plus lifestyle measures helps normalize blood glucose more often than lifestyle measures alone.
- Ssemaglutide may decrease the risk of cardiovascular disease.
People from some minority ethnic family backgrounds have an equivalent risk of obesity with a lower BMI than people from white ethnic family backgrounds. In addition, the NICE obesity guideline recommends using lower BMI thresholds for people of South Asian, Chinese, other Asian, Middle Eastern, black African or Afro-Caribbean family origin when identifying the risk of developing type 2 diabetes and providing interventions to prevent it. Therefore, a similar adjustment in the BMI threshold is appropriate when considering the use of semaglutide.
It is appropriate to use semaglutide alongside lifestyle interventions provided in specialist weight management services (offered on the NHS for a limited time). This is because it is in line with the clinical trial and there is no evidence of efficacy if semaglutide is used as a single, stand-alone treatment. In addition, the marketing authorization specifies its use as a complement to a low-calorie diet and increased physical activity.
For people who have at least one weight-related comorbidity and a BMI of at least 35 kg/m 2 or a BMI of 30 kg/m 2 to 34.9 kg/m 2 and who also meet the NICE criteria for referral to a weight management specialist the cost-effectiveness estimates for semaglutide are likely to be within what is normally considered a cost-effective use of NHS resources. For these groups, semaglutide is recommended along with lifestyle interventions in an appropriate multidisciplinary setting.
The warning is given that unregulated use of semaglutide for weight loss poses a threat to patient safety.
