Tirzepatide is recommended as an option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity in adults, only if they have:
an initial body mass index (BMI) of at least 35 kg/m2 and
at least 1 weight-related comorbidity.
Use a lower BMI threshold (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.
If less than 5% of the initial weight has been lost after 6 months on the highest tolerated dose, decide whether to continue treatment, taking into account the benefits and risks of treatment for the person.
These recommendations are not intended to affect treatment with tirzepatide that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.
Why the committee made these recommendations
Managing overweight and obesity in adults includes diet and exercise support in primary care, but the level of support available varies and may change in the future. Some people may also have semaglutide alongside diet and exercise support if their obesity is managed in a specialist weight management service. Tirzepatide can be used in primary care or specialist weight management services.
Clinical trial evidence suggests that tirzepatide with diet and exercise support is more effective compared with diet and exercise support alone. Indirect comparisons suggest it is more effective compared with semaglutide alongside diet and exercise support.
The company proposed that tirzepatide could be used for adults with a BMI of at least 30 kg/m2 and at least 1 weight-related comorbidity. But, the most likely cost-effectiveness estimates for this group are above the range that NICE considers an acceptable use of NHS resources. So, tirzepatide cannot be recommended for this group. The most likely cost-effectiveness estimates for adults with an initial BMI of at least 35 kg/m2 and at least 1 weight-related comorbidity are within the range that NICE considers an acceptable use of NHS resources. So, tirzepatide is recommended for this group.