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NICE recommends liraglutide

In final guidance published today, NICE recommends liraglutide 1.2 mg daily for some people with type 2 diabetes mellitus. However, it does not recommend liraglutide 1.8 mg daily, because the available evidence does not suggest any significant additional benefit with the higher dose.

Liraglutide 1.2 mg daily in dual therapy regimens (in combination with metformin or a sulphonylurea) is recommended as an option for the treatment of people with type 2 diabetes, only if:

  • The person is intolerant of either metformin or a sulphonylurea, or treatment with metformin or a sulphonylurea is contraindicated, and
  • The person is intolerant of thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors, or treatment with thiazolidinediones and DPP-4 inhibitors is contraindicated.

As part of triple therapy regimens, liraglutide 1.2 mg daily is recommended (in combination with metformin and a sulphonylurea, or metformin and a thiazolidinedione) only when control of blood glucose remains or becomes inadequate (HbA1c ≥7.5%, or other higher level agreed with the individual). The patient being treated must also have either:

  • A body mass index (BMI) of ≥35kg/m2 (in those of European descent, and appropriate adjustments made for other ethnic groups), and specific psychological or medical problems associated with high body weight
  • A BMI ≤35 kg/m2, where insulin therapy would have significant occupational implications, or weight loss would benefit other significant obesity-related comorbidities.

Treatment with liraglutide 1.2 mg daily should only be continued if the person's diabetes has shown a beneficial metabolic response; defined as a reduction of at least 1% in HbA1c at 6 months for dual therapy regimens, and for triple therapy regimens, defined as a reduction of at least 1% in HbA1c and a weight loss of at least 3% of initial body weight at 6 months.

However, NICE does not recommend liraglutide 1.8 mg as a treatment option for people with type 2 diabetes. The independent Appraisal Committee concluded that, because the clinical data showed that there was only a marginal benefit from using the higher dose of liraglutide 1.8 mg compared with liraglutide 1.2 mg, (and no clinical trial has evaluated the effects of dose escalation with liraglutide from 1.2 mg to 1.8 mg), treatment with the higher dose was not justified.

Dr Carole Longson, Health Technology Evaluation Centre Director at NICE said: “Type 2 diabetes affects around 2.25 million people in the UK, so we are pleased to recommend liraglutide 1.2 mg daily as a clinically and cost-effective treatment option for some patients with the disease. We were unable to recommend use of the higher dose, however, as the available evidence does not suggest any significant additional benefit.”