The UK's bet on GLP1

Just as obesity is a global issue, GLP1 Receptor Agonists are increasingly looking like a global solution. Every country in the world with citizens that struggle with obesity and type 2 diabetes is jockeying for access and the ability to produce GLP1 Receptor Agonists.

Tirzepatide (Mounjaro, Zepbound) approved in the UK for Obesity in June

One of the biggest moves this year has been the UK's approval of Tirzepatide (the GLP1 formulation used in brands Mounjaro and Zepbound) for use in treating obesity:

Mounjaro is second obesity drug to be approved for use in England

Those with BMI of 35 and a comorbidity could be prescribed tirzepatide and Nice says it is more effective than Wegovy

The GuardianDenis Campbell

The UK now has official guidance that recommends the use of Tirzepatide in treating patients with Obesity, produced by the National Institute for Health and Care Excellence (NICE):

Draft Guidance Document.docx | Tirzepatide for managing overweight and obesity | Tirzepatide for managing overweight and obesity [ID6179] | Consultations | NICE

NICE

Building patient confidence in GLP1s in the UK

The UK has undergone many steps to start increasing confidence in the viability and safety of GLP1 Receptor Agonists in the UK. One of which is producing an extensive Frequently Asked Questions (FAQ) document on the drugs that can be accessed online:

GLP-1 agonists

GLP-1 agonists are a type of medication you might need to take if you have type 2 diabetes. They are also known as GLP-1 analogues, GLP-1 RAs and incretin mimetics.

Diabetes UK

As of earlier this year there were only 6 GLP1 Receptor Agonists available in the UK:

• Exenatide (Byetta)
• Liraglutide (Victoza/Saxenda)
• Lixisenatide (Adlyxin)
• Dulaglutide (Trulicity)
• Semaglutide (Ozempic, Wegovy)
• Tirzepatide (Mounjaro, Zepbound)

This list is bound to grow as more drugs pass the quality standards set by the UK and other countries, but it is clear that the UK is not shy about allowing GLP1 Receptor Agonists onto it's list of approved medications.

UK warnings of side effects in October

As use has increased in the UK, health care professionals are also being warned about the possibility of misuse of the drugs.

GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse

Healthcare professionals are reminded to inform patients about the common and serious side effects associated with glucagon-like peptide-1 receptor agonists (GLP-1RAs).

GOV.UKMedicines and Healthcare products Regulatory Agency

Clearly, GLP1 Receptor Agonists are not miracle drugs (nor are they purely for vanity), and they do have side effects that can be serious. We've covered many of them, and actively look for more:

Are GLP1 side effects all the same?

Do some GLP1s have less negative side effects? They work the same, but can affect you differently -- let’s look at the research.

GLP1 GuideGLP1.Guide Staff

The UK also keeps helpful explainers on hand to ensure patients are up to date on the possible side-effects of GLP1 receptor agonists:

Diabetes medicines: GLP-1 agonists - Overview

How medicines called glucagon-like peptide 1 (GLP-1) agonists help you to manage type 2 diabetes, together with healthy lifestyle changes.

Guy's and St Thomas' NHS Foundation Trust

Though we find that there are more serious side effects, the most prominently listed ones on the NHS website are:

• Feeling sick (nausea) and diarrhoea (these usually go away with time)
• Stomach pains
• Constipation (when you find it hard to poo or go to the toilet less often than usual)
• Having less appetite
• Low blood sugar (hypoglycaemia or hypos)
• Headaches
• Skin reactions if you inject your medicine

Compared to many other medications meant to treat even more benign diseases, this is a relatively small side effect list, and a cause for celebration, given the efficacy of GLP1 Receptor Agonists, as a class of drugs.

Another area of concern has been the effect of GLP1 Receptor Agonists on pregnancies, and the UK's Teratology Information Service (UKTIS) has responded to this head on:

USE OF GLP-1 RECEPTOR AGONISTS IN PREGNANCY – UKTIS

Evidence-based safety information about medication, vaccine, chemical and radiological exposures in pregnancy - UKTIS logo

Importantly they have found that there is no current evidence of negative effects of GLP1s on pregnancies or an increase in miscarriages or related issues that can be attributed to GLP1 Receptor Agonists:

Evidence regarding the safety of GLP-1 RAs in pregnancy is limited, consisting of a small number of uncontrolled case reports and two controlled studies which describe pregnancies where GLP-1 RAs were mainly discontinued in early to mid-pregnancy. As such, limited conclusions can be provided about the safety of longer-term GLP-1 RA use in pregnancy. However, GLP-1 RAs have high molecular masses, and therefore, placental transfer is not expected.

While a lack of evidence of danger does not mean GLP1s are cleared as safe, it is somewhat good news that there are no direct correlations found yet.

That said, UKTIS and other health organizations routinely suggest weight loss prior to/during pregnancy via eating a healthy diet and being active, not GLP1 receptor agonists or even caloric deficits for safety reasons:

Obesity is associated with increased risks of adverse pregnancy and fetal outcomes, and obese women are encouraged to eat a balanced healthy diet and be physically active (moderate-intensity). Dieting through calorie deficit, and anti-obesity or weight loss medications are not routinely recommended in pregnancy.

Another narrative that the UK has sought to restrict is the idea of GLP1 receptor Agonists as beauty drugs – they're meant to treat type 2 diabetes and obesity where possible, and not intended to be used purely for vanity reasons.