Dear colleagues,
We are writing to provide an update on the national GLP1-RA supply situation for the indications of both type 2 diabetes and obesity.
Please see the attached national patient safety alert (NPSA) for GLP1-RAs, issued on 3 January 2024 – here. This supersedes the previous publication from 2023.
Main changes:
- “Rybelsus® (semaglutide) tablets are now available in sufficient quantities to support initiation of GLP1 RA treatment in people with type 2 diabetes (T2DM) in whom new initiation of GLP-1 RA therapy would be clinically appropriate”
- Victoza® (liraglutide) and Ozempic® (semaglutide) are still not available in sufficient quantities to support initiation in people with type 2 diabetes
- “Saxenda® (liraglutide) and Wegovy® (semaglutide) remain available on the NHS via specialist weight management services”. Note further detail on this below specific to NHS Scotland.
- Supply of GLP1-RAs in UK are not expected to stabilise now until end of 2024 at the earliest.
We would encourage all diabetes and obesity clinicians and prescribers of GLP1-RAs to read the full NPSA document attached as there are important new actions contained within this.
Diabetes UK have updated their public information FAQs – GLP-1 RA shortages | Diabetes UK which you may find useful to signpost patients and colleagues to.
Obesity and weight management specific information:
Work is underway via a national expert group to develop a Scotland-wide consensus statement for the safe prescribing of GLP1-RAs for the indication of obesity. The current eligibility criteria set by SMC for Wegovy® (semaglutide) is for people with a BMI>30 and one weight-related complication e.g. type 2 diabetes, hypertension. NHS boards and clinicians raised significant concerns about capacity, stock and resource to meet the population need if the SMC criteria was implemented with immediate effect. An approach to look at risk stratification of patients and those who would benefit most from this treatment is therefore underway and at present, no boards have added Wegovy® (semaglutide) to formulary. The SLWG is hoping to produce guidance no later than March 2024 to then allow boards to proceed to formulary application. This is being done in close collaboration with area drugs and therapeutic committees, via the HIS collaborative. We are aware that many patients are waiting eagerly for access to this in Scotland. If there are any queries about the work of this expert group, please contact Laurie Eyles (laurie.eyles@gov.scot).
GLP1-RA treatment for people with type 2 diabetes:
Data reliably shows that the vast majority of people living with type 2 diabetes also have a BMI>30 which means they would meet current SMC criteria for Wegovy® (semaglutide). It is worth bearing this in mind in the context of supplies shortages for GLP1-RAs specifically indicated for glycaemic control for type 2. The national SLWG are considering this in the guidance development in terms of patient stratification for access. There is a strong consensus that those living with type 2 benefit from this treatment significantly in multiple ways – weight loss, CVD risk reduction and glycaemic control.
Please circulate this widely within your networks, ensuring pharmacy and prescribing colleagues locally are sighted.
Best wishes
Prof. Brian Kennon MD, FRCP Laurie Eyles, RD
Consultant in Diabetes & Endocrinology Professional Adviser, Diet and Healthy Weight Team
National Lead for Diabetes Scottish Government
Queen Elizabeth University Hospital, Glasgow
