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New weight-loss treatment for high-risk obese patients approved by NICE

By Emma Wilkinson

02 Feb 2021

The use of liraglutide as an obesity treatment on the NHS for patients with pre-diabetes under the care of specialist weight loss clinics has been approved by NICE.

The GLP-1 agonist, also known as Saxenda, will be made available through specialist tier 3 weight management services in England and Wales for patients with a body mass index (BMI) over 35 kg/m2 who also have non-diabetic hyperglycaemia and high cardiovascular disease risk.

Patients from some minority ethnic groups – including south Asian, Chinese, black African and African-Caribbean populations – who have a higher risk from diabetes and cardiovascular disease as a result of obesity will be able to access the injectable drug with a BMI of 32.5 kg/m2 or more, NICE said.

In making the recommendation, the NICE guideline committee also pointed out that access to tier 3 weight loss services ‘varies’ across the country.

However, they agreed it should only be provided in the context of these specialist clinics where appropriate weight loss advice and psychological support could be provided.

A commercial deal has been reached with Novo Nordisk, the makers of liraglutide, to the NHS with a discount through the specialist clinics, NICE said.

Non-diabetic hyperglycaemia was defined in the guidance as a HbA1c level of 42 mmol/mol to 47 mmol/mol or a fasting plasma glucose level of 5.5 mmol/l to 6.9 mmol/l.

NICE said that any adults already on the treatment before the guidance came into force could continue under the existing arrangement.

The recommendations are based on the patient having a maximum of two year’s worth of the treatment.

NICE said this duration is ‘not ideal’ because obesity is a chronic condition, but acknowledged that patients are usually discharged from tier 3 services after this period.

Patients’ other treatment options on the NHS are lifestyle measures alone, lifestyle measures with orlistat, or bariatric surgery.

The committee said there was clinical evidence that people lose more weight with liraglutide plus lifestyle measures than with lifestyle measures alone and that the drug could delay the development of type 2 diabetes and cardiovascular disease.

Last year NICE approved an oral version of GLP-1 agonist semaglutide for use in patients with type 2 diabetes. It had also been shown to help patients lose weight.

A version of this story first appeared on our sister publication, Pulse.

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