Scottish Government and NHS Scotland issue consensus on GLP-1-based obesity therapies

The Scottish Government and NHS Scotland have released a landmark consensus statement aimed at standardising the use of injectable weight management drugs across the country.

This initiative seeks to address disparities in treatment availability among Health Boards and streamline pathways for accessing GLP-1-based therapies, including liraglutide (Saxenda®), semaglutide (Wegovy®), and tirzepatide (Mounjaro®).

The guidance, developed by a multidisciplinary working group chaired by the Professional Adviser in the Diet and Healthy Weight Team of the Scottish Government, was circulated to Health Boards on October 10, 2024. Dubbed the "Once for Scotland" approach, it builds on earlier recommendations for liraglutide and semaglutide and incorporates new protocols for tirzepatide.

The consensus emphasises the phased introduction of these therapies to ensure manageable implementation across various healthcare settings. It recommends that patients can be treated in any setting where evidence-based lifestyle support is available, including primary care, community care, and specialist services.

The rollout of GLP-1-based therapies will occur in three phases:

Phase 1: Priority will be given to patients with a BMI ≥38 kg/m² (or ≥35 kg/m² in high-risk ethnic groups) alongside obesity-related conditions or Edmonton Obesity Staging System stage 3 or 4. Exceptions will be made for patients requiring treatment to qualify for essential interventions such as life-saving surgery or fertility treatments, subject to approval.

Phases 2 and 3: Future phases will extend access to those with BMI thresholds of ≥35 kg/m² (≥32 kg/m² in certain ethnic groups) and ≥30 kg/m² (≥27 kg/m² in certain ethnic groups), alongside one or more obesity-related conditions. No timelines have been set for these phases.

The working group acknowledges significant resource challenges in implementing the guidance uniformly. For example, NHS Greater Glasgow & Clyde has advised prescribers to refrain from offering these medications until appropriate pathways are in place and they are added to its formulary.

The Scottish consensus diverges from England and Wales, where the NICE Technology Appraisal on tirzepatide, due on December 19, 2024, is expected to recommend a staged rollout over 12 years. England's criteria prioritise individuals with BMI ≥40 kg/m² and multiple comorbidities, a narrower scope than Scotland's broader inclusion criteria.

Pharmaceutical manufacturer Eli Lilly has partnered with the UK Government to explore innovative obesity care models, including the SURMOUNT-Real UK study. This trial, led by Professor Martin Rutter, will evaluate tirzepatide's effects in primary care settings, aiming to measure weight loss, comorbidity prevention, and broader health outcomes over five years.