Place in the treatment pathway relative to other available treatments
Tirzepatide should be thought about as an option for individual people in line with NICE's guideline on overweight and obesity management. The visual summary care pathway has an overview.
Table 4 is also available in section 1.17 of NICE's draft guideline on overweight and obesity management.
| - | Tirzepatide | Semaglutide | Liraglutide | Orlistat |
|---|---|---|---|---|
|
For more details see |
NICE's technology appraisal guidance on tirzepatide for managing overweight and obesity (TA1026, December 2024) |
NICE's technology appraisal guidance on semaglutide for managing overweight and obesity (TA875, March 2023) |
NICE's technology appraisal guidance on liraglutide for managing overweight and obesity (TA664, December 2020) |
There is no NICE technology appraisal guidance on orlistat |
|
For people with |
An initial BMI of at least 35 kg/m2 and at least 1 weight-related comorbidity. (TA1026, December 2024) |
One weight-related comorbidity and:
or
|
An initial BMI of 35 kg/m2 or more and non-diabetic hyperglycaemia and a high risk of cardiovascular disease. |
A BMI of 30 kg/m2 or more or a BMI of 28 kg/m2 or more and associated risk factors. (orlistat summary of product characteristics [SPC]) |
|
Setting |
Prescribed in all settings. |
Prescribed in a specialist overweight and obesity management service. |
Prescribed in secondary care by a specialist overweight and obesity management service. |
Prescribed in all settings and available in a lower dose from a pharmacy. |
|
Route and frequency |
Weekly subcutaneous injection. |
Weekly subcutaneous injection. |
Daily subcutaneous injection. |
Oral capsule, up to 3 times a day. |
|
Pregnancy and contraception |
Do not use in pregnancy or in women of childbearing potential not using contraception. Switch to a non-oral contraceptive method, or add a barrier method of contraception on initiation and after each dose escalation for 4 weeks. |
Do not use in pregnancy. Women of childbearing potential are recommended to use contraception. (semaglutide SPC) |
Do not use in pregnancy. (liraglutide SPC) |
Caution in pregnancy. The use of an additional contraceptive method is recommended to prevent possible failure of oral contraception that could occur in case of severe diarrhoea. (orlistat SPC) |
|
When to stop treatment |
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. |
Consider stopping if less than 5% of the initial weight has been lost after 6 months of treatment. |
Stop after 12 weeks on the 3.0 mg/day dose if at least 5% of the initial body weight has not been lost. |
Stop after 12 weeks if at least 5% of the initial body weight has not been lost. |
The draft guideline defines specialist overweight and obesity management services as specialist primary, community or secondary care-based services led by a multidisciplinary team, offering a combination of nutritional, psychological and surgical interventions, and medicines. These services can include but are not limited to tier 3 and tier 4 services.
Semaglutide and liraglutide are recommended for use within specialist weight management services, which are usually accessed for up to 2 years.
For tirzepatide, semaglutide and liraglutide, use lower BMI thresholds (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.
Non-diabetic hyperglyacaemia is defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol (6.0% to 6.4%) or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre.
Naltrexone-bupropion is not recommended in NICE's technology appraisal guidance on naltrexone–bupropion for managing overweight and obesity in adults.
NICE's early value assessment on digital technologies for delivering multidisciplinary weight-management services covers technologies that can be used in the NHS, while more evidence is generated. They can be used to prescribe and monitor weight-management medicines and deliver multidisciplinary weight-management services.
The local formulary decision-making group will need to agree on where tirzepatide will be started locally, and arrangements for ongoing prescription.