Shortage of GLP-1 Receptor Agonists Update
An update to the original National Patient Safety Alert has been issued in response to the continued very limited, intermittent supplies of all injectable glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and supplies are now not expected to stabilise to meet full market demand until at least the end of 2024. Much of the supply issues have been caused by an increase in demand for these products for licensed and off-label indications.
The products affected are:
Semaglutide:
- Ozempic® 0.25 mg, 0.5mg and 1mg solution for injection in pre-filled pens
Dulaglutide:
- Trulicity® 0.75 mg, 1.5mg, 3mg and 4.5mg solution for injection in pre-filled pens
Liraglutide:
- Victoza® 6mg/ml solution for injection in pre-filled pens
- Saxenda® 6mg/ml solution for injection in pre-filled pens
Exenatide:
- Byetta® 5micrograms/0.02ml and 10micrograms/0.04ml solution for injection 1.2ml pre-filled pens
- Bydureon® 2mg/0.85ml prolonged-release suspension for injection 1.2ml pre-filled pens
Patients established on GLP-1 RA products may not be able to access these products which could result in treatment failure and/or a loss of blood glucose control and have serious clinical implications in the management of patients with type 2 diabetes including the risk of future cardiovascular events and diabetic ketoacidosis.
Prescribers are being advised to (updated advice in BOLD):
- only prescribe GLP-1 RAs for their licensed indications
- not initiate new patients on GLP-1 RAs for the duration of the shortage
- prescribe Rybelsus® tablets for new initiations of a GLP-1 RA (in line with NICE NG28)
- identify patients prescribed Byetta® and Victoza® injections and (in line with NICE NG28) switch to Rybelsus® tablets
- not switch between strengths of a GLP-1 RA solely based on availability including where a higher-dose preparation of GLP-1 RA is not available, not to substitute by doubling up a lower-dose preparation
- not to prescribe excessive quantities, limiting prescribing to minimise risk to the supply chain whilst acknowledging the needs of the patient
Mounjaro® (tirzepatide) is licensed for both type 2 diabetes and weight management and is available at present as 2.5mg/0.6ml and 5mg/0.6ml solution for injection to support both new patient initiations and any patients unable to obtain their existing GLP-1 RA therapy. (Higher strengths will become available in coming months)
Advice for Pharmacy Teams
- Reassure patients that there are alternative treatment options for Type 2 Diabetes and not to try to obtain GLP-1 RA stock from anywhere other than a registered UK pharmacy
- If stock cannot be guaranteed to fulfil a prescription, signpost the patient to their clinician for a reassessment of their treatment plan as alternative glucose-lowering therapy will need to be considered.
- Be familiar with the guidance produced by NICE CG28 and Joint PCDS and ABCD guidance which details the decision-making pathways for Type 2 diabetic treatment
Supplies of both Saxenda® (liraglutide) and Wegovy® (semaglutide), GLP-1 RAs licensed for weight loss are also limited and intermittent at present.