Obesity drug approved by NICE

Liraglutide (Saxenda) is recommended by NICE as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults. It can be considered for people with all of the following:

• a BMI of at least 35kg/m² (or at least 32.5kg/m² for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population),
• non-diabetic hyperglycaemia (HbA_1c 42–47mmol/mol [6.0–6.4%] or fasting plasma glucose 5.5–6.9mmol/litre), and
• a high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.

NICE says the injectable GLP-1 agonist must be prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service, and its approval is conditional on the company providing the drug according to the commercial arrangement.

Like human GLP-1, liraglutide regulates appetite by increasing feelings of fullness and satiety, while lowering feelings of hunger and prospective food consumption, thereby leading to reduced food intake. 

Clinical trials

The safety and efficacy of liraglutide for weight management in conjunction with reduced calorie intake and increased physical activity was evaluated in the SCALE (Satiety and Clinical Adiposity - Liraglutide Evidence) clinical trial programme, which included over 5,000 participants.

Across all SCALE clinical trials, people with overweight or obesity treated with liraglutide 3mg achieved superior weight loss compared with those who received placebo, and a greater proportion of people achieved >5% and >10% weight loss. 

At the end of the SCALE obesity and prediabetes trial (at 160 weeks), people treated with liraglutide 3mg were less likely to have been diagnosed with type II diabetes than those who received placebo (3% vs 11%, respectively).

The most common adverse events seen with liraglutide were transient gastrointestinal adverse events including nausea, vomiting, diarrhoea and constipation. 

COVID-19

Professor Carel Le Roux, Professor of Metabolic Medicine at Imperial College London, said: 'It has never been more important for the healthcare community to prioritise supporting people living with obesity, given its strong links to poorer outcomes with COVID-19, as well as a range of other conditions including diabetes and cardiovascular disease. Saxenda (liraglutide 3mg) has a well-established record in not only promoting weight loss but enhancing cardiometabolic benefits for patients. The addition of this treatment on the NHS is fantastic news, as it offers the potential to help patients whilst alleviating pressure on the NHS during this challenging time.'