Semaglutide Tablets

Background

Recommendation: GREEN (restricted) as an alternative GLP-1 receptor agonist for patients who are unable to use subcutaneous formulations or patients who prefer oral administration. The effectiveness of semaglutide should be monitored 6 months after initiation in line with the targets below:

Semaglutide is an appropriate treatment option for initiation and ongoing prescribing in both primary and secondary care when prescribed in the following clinical circumstances:

• after second intensification of therapy fails to achieve targets*:
  • has a BMI of ≥35 kg/m2 and specific psychological or other medical problems associated with obesity (adjust accordingly for people from Black, Asian and other minority ethnic groups) or
  • has a BMI ˂ 35 kg/m2 and
    • if insulin therapy would have significant occupational implications or
    • if weight loss would benefit other significant obesity related comorbidities

Or, with specialist care advice and ongoing support from a consultant-led multidisciplinary team:

• combined with insulin at second intensification of treatment in patients who cannot take metformin

Semaglutide may only be continued if the person has a beneficial metabolic response, defined as follows:

• a reduction of HbA1c by at least 11 mmol/mol [1.0%] and
• a weight loss of at least 3% of initial body weight in 6 months

* Wording consistent with LSCMMG antihyperglycaemics guideline