NICE has approved the use of liraglutide as an obesity treatment on the NHS for patients with pre-diabetes under the care of specialist weight loss clinics.
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 a 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.
But GPs may end up seeing an increase in workload from more patients requesting a referral to clinics, which could also mean practices carrying out more blood tests, one specialist GP has warned.
The news comes as the BMA’s GP Committee is to discuss the introduction of a new enhanced service on obesity and weight management with NHS England, with the aim for implementing it during 2021/22.
The Government had previously backed new QOF incentives aimed at encouraging GPs to refer more patients to weight management clinics – which the BMA opposed.
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.
But GPs could see an influx of patients asking for a referral to get the new drug, said Dr Patrick Holmes, a GP with a specialist interest in diabetes.
Dr Holmes, who is NHS Tees Valley CCG’s clinical lead for diabetes, welcomed the move to offer the drug on the NHS, but added: ‘If people are aware of this as a new treatment option – or if they’ve been accessing it privately – they may want to be referred to a tier 3 service, whereas previously they haven’t.’
Secondary care providers running specialist clinics could also require GPs to carry out blood tests under referral criteria they set, he said.
The GP also warned some patients may want to continue taking the drug beyond the two years.
He said: ‘I can see down the line there will be a whole bunch of patients who have achieved significant weight loss with this product and will want to continue with it – bearing in mind if they stop, their weight will come back on. This is going to be challenging in primary care.’
NICE’s two new QOF obesity indicators drafted last year had aimed at incentivising GPs to refer all obese patients to weight management services.
However, the BMA said it ‘cannot support’ the measures because GPs are largely not involved in referring overweight patients unless they are morbidly obese.
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.