1 Recommendations
1.1
Semaglutide is recommended as an option for weight management, including weight loss and weight maintenance, alongside a reduced-calorie diet and increased physical activity in adults, only if:
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it is used for a maximum of 2 years, and within a specialist weight management service providing multidisciplinary management of overweight or obesity (including but not limited to tiers 3 and 4), and
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they have at least 1 weight-related comorbidity and:
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the company provides semaglutide according to the commercial arrangement.
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 family backgrounds.
1.2
Consider stopping semaglutide if less than 5% of the initial weight has been lost after 6 months of treatment.
1.3
These recommendations are not intended to affect treatment with semaglutide 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 clinician consider it appropriate to stop.
Why the committee made these recommendations
Management of overweight and obesity in adults includes lifestyle measures alone or with orlistat, or referral to specialist weight management services (such as tier 3 or 4), which might include liraglutide or bariatric surgery.
Clinical trial evidence shows that:
people lose more weight with semaglutide alongside supervised weight management support than with the support alone
more weight is lost with semaglutide than with liraglutide
in people with non-diabetic hyperglycaemia, semaglutide plus lifestyle measures helps normalise blood glucose more frequently than lifestyle measures alone
semaglutide may decrease the risk of cardiovascular disease.
People from some minority ethnic family backgrounds have an equivalent risk from obesity at a lower BMI than people from a White ethnic family background. Also, NICE's guideline on obesity recommends using lower BMI thresholds for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds when identifying the risk of developing type 2 diabetes and providing interventions to prevent it. So, a similar adjustment in the BMI threshold is appropriate when considering using semaglutide.
It is appropriate to use semaglutide alongside lifestyle interventions that are provided in specialist weight management services (offered in the NHS for a limited time). This is because it is in keeping with the clinical trial, and there is no evidence of effectiveness if semaglutide is used as a single stand-alone treatment. Also, the marketing authorisation specifies use as an adjunct to a reduced-calorie diet and increased physical activity.
For people who have at least 1 weight-related comorbidity and a BMI of at least 35 kg/m2 or a BMI of 30 kg/m2 to 34.9 kg/m2 and also meet the NICE criteria for referral to a specialist weight management service, the cost-effectiveness estimates for semaglutide are likely to be within what is normally considered a cost-effective use of NHS resources. For these groups, semaglutide is recommended alongside lifestyle interventions in an appropriate multidisciplinary setting.