Scotland first UK nation to clear Mounjaro use for obesity

Scotland has become the first country in the UK to back NHS use of Eli Lilly’s obesity therapy Mounjaro, clearing it to assist weight management in eligible patients.

The Scottish Medicines Consortium (SMC) has said that Mounjaro (tirzepatide) can be used within the NHS for weight loss and weight maintenance – alongside a reduced-calorie diet and increased physical activity – in adults with a body mass index (BMI) of 30 kg/m2 or more and at least one weight-related comorbidity like pre-diabetes, diabetes, high blood pressure, or high cholesterol.

That’s in line with the MHRA-approved label for Mounjaro in obesity, but comes a few days after the SMC’s counterpart south of the border – the National Institute of Health and Care Excellence (NICE) – issued a draft recommendation limiting use of the drug to adults with a BMI of 35 kg/m2 or more and at least one comorbidity.

At the time, obesity expert and physiologist Dr Simon Cork of Anglia Ruskin University said that there are “very few patients in the UK” with a BMI of 35 kg/m2 and over and a comorbidity. NICE said in its appraisal that use of the drug in people below that threshold would not be a cost-effective use of NHS resources.

The SMC meanwhile notes that patients from certain ethnic minority groups could also be considered for treatment, even if they have a BMI below 30 kg/m2, and NICE has adopted a similar position for the drug – albeit in the context of the higher threshold – in its draft guidance.

Misaligned cover within the UK

The disparity in access to tirzepatide between Scotland and England/Wales – assuming NICE sticks with its current plan – adds to an increasingly complex environment for the much-touted new weight-loss therapies within the UK.

For example, both the NICE and SMC guidances do not restrict use of Mounjaro to specialist weight management services, meaning that eligible adults should be able to access treatment through primary care. That’s not the case for Novo Nordisk’s rival obesity drug, Wegovy (semaglutide), which has been covered by the NHS since September but only through specialist services.

Access to weight-loss clinics is patchy across the UK, which could limit access to Wegovy in some areas. Moreover, under current NHS guidelines, people can only access these services for up to two years, which ties in with a two-year cap on the use of Wegovy, while for Lilly’s drug there is no overt time limit.

“This is an important moment for people living with obesity, because until recently, treatment options for obesity have been limited, so having access to treatments that can help people lose weight and maintain the weight loss is a huge step forward,” said Sarah Le Brocq, director and founder of the All About Obesity patient organisation.

“Access to support and to effective treatments is vital to help improve quality of life, and has the potential to help an estimated 1 million people in Scotland,” she added.

Comments are due on NICE’s draft guidance for Mounjaro by 25th June, with a final recommendation scheduled for the end of October.

Lilly’s head of international medical affairs Prof Rachel Batterham, said the company is “continuing to work closely with relevant bodies across the UK with the aim of enabling patients the same opportunity to access the treatment and support they deserve.”