NICE plans to approve semaglutide for some obese adults, according to draft guidance.

Adults eligible for semaglutide, a glucagon-like peptide-1 receptor agonist, for weight loss should have at least one weight-related comorbidity and a body mass index (BMI) of at least 35.0kg/m². 

Some patients with a BMI of 30.0kg/m² to 34.9kg/m² may be eligible based on NICE’s clinical guideline on obesity. BMI thresholds are lower (usually by 2.5kg/m²) for people from south Asian, Chinese, Black African and Caribbean backgrounds. 

Semaglutide should be prescribed by a specialist weight management service with multidisciplinary input and used for a maximum of two years. NICE’s clinical experts expect that most people will gain some weight after stopping semaglutide. They noted, however, “that the assumptions around the rate of weight gain after treatment are very uncertain”. 

NICE concluded that semaglutide is more effective than placebo. A subgroup analysis of a clinical trial included adults with a BMI of 30kg/m² or more with at least one weight-related comorbidity. After 68 weeks, patients lost a mean of 12.2 per cent more body weight compared with placebo. Semaglutide is also used for type 2 diabetes. 

The subgroup analysis found that 79.2 per cent of those taking semaglutide shifted from non-diabetic hyperglycaemia to normoglycaemia compared with 20.0 per cent with placebo. The manufacturer’s analyses found that people using semaglutide lose between 5.81 and 9.38 per cent more weight than with liraglutide after 68 weeks. 

A commercial agreement allows the NHS to purchase semaglutide for weight loss below the list price.