Obese patients could potentially be given PBS-subsidised access to lifelong therapy with weekly injections of the GLP-1 agonist semaglutide in nurse-led or GP-led models of care, according to scenarios discussed by the Pharmaceutical Benefits Advisory Committee (PBAC).
The drug is currently available on the PBS for treatment of people with type 2 diabetes, but with the TGA now assessing an application for semaglutide to be used in weight management the PBAC recently convened a stakeholder meeting to help inform its consideration of an expected application for a PBS listing for semaglutide for this indication.
The meeting held on 26 August was attended by a Staff Specialist in Endocrinology from Sydney’s Royal North Shore Hospital as well as representatives from obesity patient groups, industry, GPs and allied health professional groups.
The meeting noted that there is currently a high unmet need for obesity treatments in the general population, with no pharmacotherapies listed on the PBS and access to bariatric surgery almost entirely limited to private hospitals, raising issue of inequity.
However while some stakeholders said that semaglutide would most likely have a role in people with more severe obesity, it was not envisaged as a replacement for bariatric surgery, but rather as an add-on therapy in addition to lifestyle change interventions.
According to the PBAC meeting outcome statement, the main goal of pharmacotherapy for obesity was likely to be sustained weight loss, “in order to reduce the likelihood of developing a range of comorbidities, such as micro/macrovascular disease complications from type 2 diabetes, cardiovascular disease, prevention of progression from pre-diabetes to diabetes, sleep apnoea and chronic kidney disease.”
This then raised the question of whether semaglutide and other pharmacotherapies would be potentially be a lifelong treatment, given that patients who achieve weight loss may put it back on due to metabolic adaptation if they stop treatment.
When evaluating a PBS listing, the PBAC would therefore have to set criteria for initiation and continuation of therapy, the meeting heard. This led to discussion around whether pharmacotherapy should be offered in settings such as primary care or in specialist and hospital-based weight loss and metabolic clinics, where obese patients are typically referred after having not responded to several attempts at weight loss.
The arguments in favour of a GP-led prescribing included their extensive experience in chronic disease management and regular patient access needed for review of therapy.