6.3.1.4 Glucagon-like peptide-1 receptor agonists

*SUPPLY ISSUE: The supplies of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) continue to be limited, with supplies currently not expected to return to normal until at least the end of 2024. Please see the SPS medicines supply tool (free subscription required) for the current stock situation and anticipated re-supply dates.

**There has been an updated Medicine Supply Notification (MSN/2024/031) on the supply issues of GLP-1 RAs released on the 18th March 2024, which supersedes the National Patient Safety Alert (NPSA) (NatPSA/2024/001/DHSC) released on the 3rd of January 2024. Please refer to the MSN/SPS medicines supply tool for further information, actions required and clinical guidance/advice on alternatives.**
*Please see information under each individual drug monograph below for further preparation specific information.*

Please note that lixisenatide (Lyxumia), all strengths, are now discontinued from December 2023. Byetta (exenatide), all strengths, will be discontinued at the end of March 2024. Please review patients prescribed Lyxumia or Byetta in line with the MSN.

Please prescribe GLP-1 RAs for licensed indications only, prescribe by brand, do not switch between strengths of a GLP-1 RA solely based on availability, do not double up a lower dose preparation where a higher dose preparation is not available, and check quantity prescribed (do not prescribe in quantities greater than one month).*

Saxenda (liraglutide), see NICE TA664, is for specialist prescribing only when used for weight management in line with the NICE TA.

**Saxenda has been affected by the national supply issues of GLP-1 RAs. Until the supply chain is restored, no referrals onto the Saxenda pathway will be accepted by the Tier 3 provider.**

Kent and Medway ICB Position Statement on Wegovy and GLP-1 RAs

Wegovy (semaglutide), see NICE TA875, is for specialist prescribing only when used for weight management in line with the NICE TA. It is only available via Tier 3 services within Kent and Medway. Only commissioned obesity services are able to undertake the appropriate level of service.

GLP1 mimetics should be initiated by clinicians who have received appropriate training (eg PITSTOP training). Adequate training on the use of the injectables and follow up reviews should be provided to patients initiated on GLP-1 mimetics. GLP-1 mimetics across Kent and Medway have a green status so can be initiated in primary, community or secondary care. Where MDT support is also possible (not for all of Kent and Medway) this can be utilised. In primary care Arden’s templates are available in EMIS to support the initiation of GLP-1 mimetics and are encouraged to be used.

Oral Semaglutide has been approved as an option for insufficiently controlled type 2 diabetes, especially where an injectable GLP-1 mimetic may not be preferrable. GLP-1 mimetic would be considered as part of this pathway. Oral semaglutide is not a replacement for injectable GLP-1 mimetics and should still be initiated by a clinician with PITSTOP or equivalent training. It can be prescribed alongside other diabetes medications (apart from DPP-4 inhibitors and other GLP-1 mimetics).

K&M type 2 diabetes guidelines in Adults