1 Recommendations

1.1

Tirzepatide is recommended for treating type 2 diabetes alongside diet and exercise in adults when it is insufficiently controlled only if:

triple therapy with metformin and 2 other oral antidiabetic drugs is ineffective, not tolerated or contraindicated, and
they have a body mass index (BMI) of 35 kg/m² or more, and specific psychological or other medical problems associated with obesity, or
they have a BMI of less than 35 kg/m², and:
- insulin therapy would have significant occupational implications, or
- weight loss would benefit other significant obesity-related complications.
  
  Use lower BMI thresholds (usually reduced by 2.5 kg/m²) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds.
  
  Tirzepatide is only recommended if the company provides it according to the commercial arrangement.

1.2

This recommendation is not intended to affect treatment with tirzepatide that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Some people with type 2 diabetes have triple therapy with metformin and 2 other oral antidiabetic drugs. When this is ineffective, not tolerated or contraindicated, they may switch one of the antidiabetic drugs for a glucagon‑like peptide‑1 (GLP‑1) receptor agonist (such as semaglutide) or start insulin therapy. For this evaluation, the company asked for tirzepatide to be considered only as an alternative to GLP‑1 receptor agonists. This does not include everyone who it is licensed for.

Clinical trial results suggest that tirzepatide reduces blood glucose levels (measured by HbA1c levels) and body weight compared with semaglutide, insulin therapy or placebo. There is only an indirect comparison of tirzepatide with other GLP‑1 receptor agonists, which suggests similar benefits, although these results are less certain.

Additional analyses provided by the company after consultation improved confidence in the clinical- and cost-effectiveness evidence. The cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So, tirzepatide is recommended for routine use in the NHS.