High Street pharmacists are set to offer the injected weight loss treatment semaglutide (Wegovy, Novo Nordisk), following its approval for weight loss by the National Institute for Health and Care Excellence (NICE). Both Boots and Lloyds Pharmacy are inviting people to register their interest, and the drug is expected to be available within their weight loss treatment services later this year. In addition, Superdrug and ASDA Online Doctor have announced that Wegovy would be available "soon".
Semaglutide is one of a range of glucagon-like peptide-1 (GLP-1) analogues that mimic the action of the hormone, so making people feel fuller and less hungry, so they eat less and reduce their overall calorie intake, said NICE. Unlike liraglutide (Saxenda, also manufactured by Novo Nordisk), which is already available from such services but requires patients to give themselves a daily subcutaneous injection using pre-filled pen syringes, Wegovy need only be injected once a week.
Wegovy is prescription-only medicine (PoM) and licensed in the UK specifically for weight loss and weight maintenance, with a dose of semaglutide in pre-filled pens ranging from 0.5 mg to 2.4 mg. Patients are put on the lowest dose for induction, increasing every 4 weeks to a maintenance dose of 2.4 mg.
An alternative form of semaglutide, under the brand name Ozempic (also PoM), is licensed in the UK only for the treatment of type 2 diabetes and indicated as an adjunct to diet and exercise in adults with insufficiently controlled type 2 diabetes mellitus.
Almost 15% Weight Loss After 15 Months
Ozempic is said to be Hollywood's 'skinny shot' of choice, and is rumoured to have been used by celebrities such as Elon Musk and Kim Kardashian. It was featured in British Vogue last month, with the magazine noting that the allegedly rapid weight loss experienced by users can lead to a range of unwanted effects such as 'Ozempic face', described as a 'gaunt' or 'deflated' appearance.
NICE draft guidance last February recommended that semaglutide could be offered as an option for weight management in adults, alongside a reduced-calorie diet and increased physical activity, only if they have at least one weight-related comorbidity and a body mass index (BMI) of at least 35 kg/m2, or, exceptionally, to people with a BMI of 30.0 kg/m2 to 34.9 kg/m2.
However, a lower BMI threshold (usually reduced by 2.5 kg/m2) was recommended for people from South Asian, Chinese, and Black African or Caribbean family backgrounds, following recommendations in NICE's guideline on preventing ill health and premature death in minority ethnic groups.
The independent appraisal committee's decision was influenced by evidence from the manufacturer's STEP 1 clinical trial, a randomised double-blind trial, which showed that participants taking semaglutide lost on average 12% more of their body weight than those taking placebo. Patients taking Wegovy achieved an average weight loss of 14.9% after 68 weeks – equivalent to a 35-lb reduction (or just under 16 kg) – compared with 2.4% (around 6 lbs, or just under 3 kg) among those on placebo, from a mean baseline BMI in both groups of 37.9 kg/m2.
The majority of patients taking Wegovy achieved "clinically meaningful weight loss", and participants who received semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in reported physical functioning than those on placebo.
Nausea and diarrhoea were the most common adverse events with semaglutide. Although they were typically transient and mild-to-moderate in severity, more participants in the active treatment group dropped out due to gastrointestinal events (4.5% vs. 0.8% in the placebo group).
Accessing Treatment Via NHS or Privately?
On the NHS, the drug can only be prescribed as part of a specialist weight management service with multidisciplinary input (such as a tier 3 weight management programme or tier 4 specialist obesity services, including surgery service), and for a maximum of 2 years.
In pharmacies, access to treatment will be subject to an online consultation with a clinician to assess suitability, and ongoing monitoring by a pharmacist, with a range of additional weight loss support services on offer.
LloydsPharmacy currently offers an online only service that prescribes weight loss drugs, such as Xenical, Orlistat, and Saxenda (liraglutide). A spokesperson for Lloyds Pharmacy told Medscape News UK that: "Patients answer medical questions as part of an online consultation. Our clinicians assess their suitability, and if it's medically appropriate, will prescribe a medicated weight loss treatment. Patients then go into their local LloydsPharmacy to collect the treatment and have their BMI checked.
The spokesperson said that they are "preparing to launch Wegovy (semaglutide) later in the year, when the treatment is available in the UK".
When patients sign up to the LloydPharmacy Online Doctor, they are asked for their NHS GP's details. Consent from the patient is needed to share anything with their GP, but "consent to share this information is mandatory for some of our services like Saxenda, and it will be for Wegovy too," the spokesperson said.
Asked if patients were coming forward for private weight loss services instead of waiting for treatment on the NHS, she said that: "Treatments like Saxenda and Wegovy would need a referral to a specialist centre if a patient is getting them through the NHS. Wait times for specialist obesity services can vary across the country.
"It's hard to say how many of our patients are on NHS waiting lists, as this isn't one of the questions in our online consultation. But what we can say is that our medicated weight loss service has supported a lot of patients on their weight loss journey. And the uptake of our service went up considerably when we added Saxenda to our treatments list. And we expect it to do the same when Wegovy becomes available."
Some Possible Serious Side Effects
She cautioned: "Digestive side effects tended to be short lived and worsen when the patient is increasing their dosage of semaglutide. There are other reported side effects like increased heart rate (around 26% of patients experience this) and hair loss (around 2.5%).
"It's also worth bearing in mind uncommon and rare side effects (which can be serious), including gall stones, acute pancreatitis, and, in patients with type 2 diabetes, diabetic retinopathy, and low blood sugar levels."
Commenting to the BBC, Tom Quinn from eating disorder charity Beat said: "Wegovy or other weight-loss medications should only be sold under the strictest possible conditions, with stringent physical and mental health checks to ensure patients are well enough."
He added: "It is vital that people are aware of the dangers of abusing medication in order to lose weight and there should be more education on their effects."
Asked to comment by Medscape News UK, a spokesperson for Boots said: "[Wegovy] will be available from Boots Online Doctor, with an anticipated launch of Spring 2023. Customers can register their interest ahead of the launch via the Boots Online Doctor platform," adding that, "Customers will have access to treatment following their completion of an online consultation form, which will be assessed by a clinician. Those who are offered treatment will receive follow up touch points and support from the Boots Online Doctor service throughout their weight loss journey and can access advice and support from our pharmacy teams in stores."
Obesity 'One of Biggest Challenges' to the NHS
NICE quoted figures from the 2019 Health Survey for England showing that an estimated 28% of adults in England were obese and a further 36% were overweight. Helen Knight, programme director at the centre for health technology evaluation at NICE, described the management of overweight and obesity as "one of the biggest challenges our health service is facing".
Government estimates indicate that the current costs of obesity in the UK are £6.1 billion to the NHS and £27 billion to wider society.
The list price of semaglutide 0.25 mg, 0.5 mg, and 1.0 mg is £73.25 per pack (four pre-filled pens; excluding VAT). The price of 1.7-m and 2.4-m syringes is commercial in confidence, NICE said. It is not yet known what it will cost within private weight loss services, but Boots currently charges around £50 per pen for Saxenda.