GPs seek clarity over semaglutide rollout for overweight patients with CVD

GPs need more clarity over how the NHS intends to provide access to weight loss jabs for people with established cardiovascular disease who are overweight, an expert has warned.

NICE has finalised guidance opening up eligibility to semaglutide (Wegovy) for people who have had a heart attack or stroke and are overweight.

Under the recommendations, published today (7 May), more than 1.2 million people will qualify for treatment alongside lifestyle changes.

ICBs will have 90 days to get plans in place to make the injections available to individuals who have had a heart attack, a stroke or have symptomatic peripheral arterial disease if they also have a BMI of at least 27 kg/m².

A resource impact report noted that there are around 2.5 million people in England with established cardiovascular disease and around half of them have a BMI of 27 or more.

Every year there are around 83,000 new diagnoses of CVD in people who would fall into this BMI category, it notes.

It is thought that over time, the population eligible under the new recommendations will fall slightly as the use of GLP-1s grows for other indications, the document adds.

First announcing the plans in April, the NICE committee made the decision based on data from the SELECT trial of more than 17,600 participants with established cardiovascular disease but not diabetes who took semaglutide or placebo alongside their existing medicines, such as statins and also had lifestyle advice. 

In 2023, the trial reported a 20% reduced risk of a serious cardiovascular event compared with placebo.

A confidential commercial deal has been agreed between the company and the NHS for Wegovy as part of the recommendation which NICE said was ‘well within’ the range it considers to be an effective use of resources.

A template produced by NICE for commissioners allows for behavioural support appointments to be costed but these were not included in the company’s cost-effectiveness modelling, it said.

‘The company thought that the level of healthy lifestyle counselling provided in both arms of the SELECT clinical trial was representative of NHS clinical practice for secondary cardiovascular event prevention,’ it continued.

Pulse has NHS England for more detail, while NICE said it would be up to ICBs to determine what additional behavioural support patients required beyond what they were receiving already.

Speaking with Pulse, Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said implementation would be challenging for the NHS.

‘General practices are already under considerable pressure, and these recommendations will substantially increase demand for clinical assessment, prescribing, monitoring and behavioural support.

He added that ensuring equitable access will be another key issue.

‘Uptake could vary significantly between different parts of the country depending on local NHS capacity and commissioning arrangements.

‘People living in more deprived communities, who often have higher rates of obesity and cardiovascular disease, must not be disadvantaged.’

The medications must not be seen as a substitute for broader public health measures, he continued.

‘Effective use of semaglutide requires ongoing behavioural and lifestyle support. GPs and patients will need clarity on who will provide this support and how these services will be funded.’

Listen to our recent podcast episode where Pulse clinical adviser Dr Keith Hopcroft interviews Professor Ahmet Fuat, honorary professor of primary care cardiology at Durham University and GP with extended role in cardiorenal medicine, about the evidence base behind the recommendation, what the roll out might look like, who is eligible, who will be responsible for managing care, and how it fits in with existing NICE guidance on treating patients with type 2 diabetes with SGLT-2 inhibitors.