Barriers and Facilitators in the use of Pharmacological
Intervention. Saxenda (Liraglutide), for
Weight Management in a Specialist Service
Barriers and Facilitators in the use of Pharmacological
Intervention. Saxenda (Liraglutide), for Weight Management in a Specialist Service
Dr Ranjana Babber, Dr AB Sirin-Ayva, Dr Sophie Edwards, Prof Paul Gately
Introduction
NICE guidance (CG189, TA664) recommends the use of Saxenda (Liraglutide) as an adjunct to a reduced calorie diet and increased physical activity for managing weight in adults living with obesity. Morelife specialist weight management service provides a comprehensive, consultant-led Saxenda pathway alongside evidence-based behaviour change intervention for sustained engagement with healthy eating and an active lifestyle.
Methods
The patients enrolled for our Greater Manchester Tier 3 adult weight management service (March 2022 – July 2023) were screened for Saxenda as per eligibility criteria defined by NICE. Those who did not achieve 5% weight loss at 4 monthly reviews or maintain the weight at a later review were discharged. A retrospective audit of data was carried out to examine and report the outcomes.
Results
A total of 112 patients were screened as eligible for Saxenda, though 75.9% (n,85) started on this pathway. A significant 17.9% could not start due to the GLP-1RA medication shortage announced by National Patient Safety Alert, DHSC July
2023. A small number of patients (2.7%) were deemed non-eligible at medical assessment, of these, 1.8% were due to achieving normoglycemia and the rest (n,1) due to contraindications to the safe use of the medication. Another 3.8%
declined the pathway primarily due to concerns related to side effects that may exacerbate their current gastrointestinal symptoms related to existing health conditions.
Attendance for a pre-scheduled 4-month review indicated that 75.3% (n,64) of the patients attended their appointment. A significant 15% (n,13) of the 4 monthly reviews were rescheduled due to stock shortages and patients were supported to restart their pathway. Another 4.7% did not attend this review as they discontinued Saxenda and sought to be discharged from the pathway due to uncertainty around medication stocks. Only 3.7% of clients discontinued due to side effects, though others reported managing it well through guidance from the team and the rest (n,1) were discharged due to house relocation. The weight loss at 4 monthly reviews highlighted a substantial change in weight (Mean -9Kg, SD 5.2,) and reportedly 85% achieved their 5% weight loss target and year 1 outcomes demonstrated cumulative weight loss (Mean -16.2Kg, SD 9.3).
During the stock shortages, our service offered bespoke support as additional 1-2-1 sessions with specialist dietitians, support from a psychologist, support for dose management or re-titration advice, peer support sessions, FAQ sessions
and coordination with a GP. Other factors such as flexibility around time, delivery (telephone/Zoom), information on managing potential side effects, mandatory attendance for behaviour change intervention, transparent and timely communications and a compassionate approach have been instrumental for client engagement and effectiveness on this pathway.
Conclusion
Interruption in the medication supply chain can abruptly interfere with the medication pathways in the specialist weight management service, and can have a considerable impact on the patient’s motivation and well-being. Supplementary Support and engagement with core behaviour change programmes are relevant considerations to manage such barriers for effective weight loss.