National Patient Safety Alert DHSC: Shortage of GLP-1 receptor agonists (GLP-1 RA) Update

This NatPSA supersedes NatPSA/2023/008/DHSC.

National Patient Safety Alert: Shortage of GLP-1 receptor agonists (GLP-1 RA) update

National Patient Safety Alert Reference Number: NatPSA/2024/001/DHSC

Date issued: 3rd January 2024

Explanation of identified safety issue

The supply of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) continue to be limited, with supply not expected to return to normal until at least the end of 2024.NOTE A The supply issues have been caused by an increase in demand for these products for licensed and off-label indications.

• Rybelsus® (semaglutide) tablets are now available in sufficient quantities to support initiation of GLP1 RA treatment in people with type 2 diabete (T2DM) in whom new initiation of GLP-1 RA therapy would be clinically appropriate.
• Byetta® (exenatide) 5micrograms/0.02ml and 10micrograms/0.04ml solution for injection 1.2ml pre-filled pens will be discontinued in March 2024.
• Victoza® (liraglutide) continues to be out of stock and further stock is not expected until end of 2024.
• Saxenda® (liraglutide) and Wegovy® (semaglutide) remain available on the NHS via specialist weight management services.

Do not prescribe GLP-1 RAs licensed for T2DM for off-label indications. Existing stock must be conserved for patients with T2DM to mitigate the risk of impaired access to treatment and increased risk in diabetes related complications.

Please refer to the public facing page on the SPS website for an overview of stock availability for all GLP-1 RAs.
Supplies of insulin remain good, however any surge in demand caused by patients requiring an escalation of treatment in the absence of GLP-1 RA stock may affect supplies.

Actions required

Actions to be completed by 28th March 2024:

Actions for clinicians and prescribers of GLP-1 RAs until supply issues have resolved

• Only prescribe GLP-1 RAs for their licensed indications.
• 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.
• Counsel patients on any changes in drug, formulation, and dose regimen where appropriate.
• Engage with patients established on affected GLP1 RAs and consider prioritising for review:
  a. discuss stopping GLP1-RA if patients have not achieved treatment goals as per NICE NG28/CG189
  b. do not double up a lower dose preparation where a higher dose preparation of a GLP-1 RA is not available.
  c. do not switch between strengths of a GLP-1 RA solely based on availability.
  d. do not prescribe excessive quantities; limit prescribing to minimise risk to the supply chain whilst acknowledging the needs of the patients.
•  Use the principles of shared decision making where an alternative agent needs to be considered, as per NICE guidelines and in conjunction with the clinical guidance.
• Support patients to access structured education and weight management programmes where available

Please see full guidance in the alert.