National Patient Safety Alert: Shortage of GLP-1 receptor agonists (GLP-1 RA) update (3 January 2024)

Summary

This is a safety critical and complex National Patient Safety Alert. Implementation should be co-ordinated by an executive lead (or equivalent role in organisations without executive boards) and supported by clinical leaders in diabetes, GP practices, pharmacy services in all sectors, weight loss clinics, private healthcare providers and those working in the Health and Justice sector.

Content

The supply of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) continue to be limited, with supply not expected to return to normal until at least the end of 2024.NOTE A The supply issues have been caused by an increase in demand for these products for licensed and off-label indications.

• Rybelsus® (semaglutide) tablets are now available in sufficient quantities to support initiation of GLP-1 RA treatment in people with type 2 diabetes (T2DM) in whom new initiation of GLP-1 RA therapy would be clinically appropriate.
• Byetta® (exenatide) 5micrograms/0.02ml and 10micrograms/0.04ml solution for injection 1.2ml pre-filled pens will be discontinued in March 2024.
• Victoza® (liraglutide) continues to be out of stock and further stock is not expected until end of 2024.
• Saxenda® (liraglutide) and Wegovy® (semaglutide) remain available on the NHS via specialist weight management services.

Actions required:

1. Only prescribe GLP-1 RAs for licensed indications.
2. Prescribe Rybelsus® tablets for new initiations of a GLP-1 RA (in line with NICE NG28).
3. Identify patients prescribed Byetta® and Victoza® injections and (in line with NICE NG28) switch to Rybelsus® tablets.
4. Counsel patients on any changes in drug, formulation, and dose regimen where appropriate.
5. Engage with patients established on affected GLP-1 RAs and consider prioritising for review: a. discuss stopping GLP1-RA if patients have not achieved treatment goals as per NICE NG28/CG189; b. do not double up a lower dose preparation where a higher dose preparation of a GLP-1 RA is not available; c. do not switch between strengths of a GLP-1 RA solely based on availability; d. do not prescribe excessive quantities; limit prescribing to minimise risk to the supply chain whilst acknowledging the needs of the patients.
6. Use the principles of shared decision making where an alternative agent needs to be considered, as per NICE guidelines and in conjunction with the clinical guidance.
7. Support patients to access structured education and weight management programmes where available.