Appetite suppressant semaglutide is to be made available to treat obesity in England
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p556 (Published 08 March 2023) Cite this as: BMJ 2023;380:p556
A drug used for treating diabetes has been recommended by the National Institute for Health and Care Excellence (NICE) to treat thousands of people with obesity in England.
Semaglutide—also called Wegovy—will be allowed to be prescribed to help people lose weight as part of their treatment in an NHS specialist weight management service.
The drug, manufactured by Novo Nordisk, works by suppressing appetite by mimicking the hormone glucagon-like peptide-1 (GLP-1), which is released after eating. It is injected once a week by patients.
NICE first recommended the drug in draft guidance last year, after a clinical trial of just under 2000 volunteers found that people lost on average 12% more weight with semaglutide alongside supervised weight loss coaching than with just coaching. The mean body mass index (BMI) in the trial was 37.9, although it did not include people with type 2 diabetes.
In final guidance,1 NICE has recommended the use of the drug alongside a reduced calorie diet and increased physical activity in adults who have at least one weight related comorbidity and a BMI of at least 35. For patients with a South Asian, Chinese, Black African, or Caribbean family background it recommends reducing the BMI threshold by 2.5, as people from some ethnic minorities have an equivalent risk from obesity at a lower BMI than people from a white background.
Weight related comorbidities could include prediabetes or type 2 diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, or cardiovascular disease.
Maximum two years
NICE recommends that the drug should be prescribed for a maximum of two years and must be delivered as part of specialist weight management services, with multidisciplinary teams who will also monitor potential side effects.
It advises that the NHS should consider stopping semaglutide if less than 5% of the patient’s initial weight has been lost after six months of treatment, given the reported side effects. During the STEP 1 clinical trial, used by NICE to help formulate its recommendations, the main side effects of semaglutide reported by patients were gastrointestinal disorders including nausea, diarrhoea, constipation, and vomiting.
The marketing authorisation indication for the drug states that it could also be prescribed to people with a BMI of 30.0-34.9 who have one weight related comorbidity and are eligible for referral to specialist weight management services.
The BMJ has previously reported that around 35 000 people could be eligible for the treatment.2
Healthy choices
The dose of semaglutide used in the STEP 1 trial was 2.4 mg. NHS England said that it could not disclose the price for treating obesity with the drug and that this should not be extrapolated from the price of lower doses of the semaglutide used in treating diabetes (0.25 mg, 0.5 mg, and 1.0 mg, at £73.25 a pack excluding VAT).
Helen Knight, director of medicines evaluation at NICE, said, “For some people losing weight is a real challenge, which is why a medicine like semaglutide is a welcome option. It won’t be available to everyone. Our committee has made specific recommendations to ensure it remains value for money for the taxpayer, and it can only be used for a maximum of two years.”
Duane Mellor, registered dietitian and a senior lecturer at Aston Medical School, commented, “Although semaglutide can be prescribed for 24 months, the support regarding lifestyle needs to continue, and as well our society needs to change to support people to continue to make healthy choices and live healthier lives.
“We need semaglutide to be seen as part of the toolkit that supports people to be able to improve their health, not a magic or singular solution.”