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Diabetes injection pen shortage to persist until ‘at least’ end of 2024

Prescribing and dispensing organisations must limit prescriptions to licensed indications only and switch some patients from the injection pens to tablets by March, the government has said. 

Supply issues for glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are used to manage blood glucose levels in people with type two diabetes, will continue “until at least the end of 2024”, the Department of Health and Social Care (DH) has announced.

In June, the DH had advised that a normal supply of the medication was “not expected to return to normal until at least mid-2024”.

But in a national patient safety alert issued to all “prescribing and dispensing” organisations yesterday (January 3), the government said that the “limited” supply has been caused by “an increase in demand for these products for licensed and off-label indications”.

It added that prescriptions of the medicines should be limited “to minimise risk to the supply chain”, including only prescribing GLP-1 RAs for licensed indications and not off-label.

“Existing stock must be conserved for patients with [type two diabetes] to mitigate the risk of impaired access to treatment and increased risk in diabetes related complications”, it said.

The DH said that by March 28, “clinicians and prescribers” should “identify patients prescribed Byetta and Victoza injections” and switch them to Rybelsus tablets, while the tablets should also be prescribed for all new initiations.

It explained that switched patients should be advised on “any changes in drug, formulation and dose regimen”.

The “safety critical and complex” alert added that “Saxenda (liraglutide) and Wegovy (semaglutide) remain available on the NHS via specialist weight management services”.

 

Affected medications

 

The GLP-1 RAs affected are:

  • Semaglutide injection: Ozempic 0.25 mg, 0.5mg and 1mg solution for injection in pre-filled pen 

  • Dulaglutide: Trulicity 0.75mg, 1.5mg, 3mg and 4.5mg solution for injection in pre-filled pens

  • Liraglutide: Victoza 6mg/ml solution for injection in prefilled pen – which continues to be out of stock with further stock not expected until end of 2024

  • Liraglutide: Saxenda 6mg/ml solution for injection in prefilled pen 

  • Exenatide: Byetta 5micrograms/0.02ml and 10micrograms/0.04ml solution for injection 1.2ml pre-filled pens – which will be discontinued in March 2024

  • Exenatide: Bydureon 2mg/0.85ml prolonged-release suspension for injection 1.2ml pre-filled pens

The alert added that 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”.

 

Ongoing supply chain issues 

 

The alert comes after weight loss drug Wegovy was launched in the UK last September, after NICE recommended it for adults with a Body Mass Index (BMI) of a minimum of 35 and one weight-related health condition such as diabetes or hypertension in March.

However, C+D found that pharmacy contractors were only able to offer Wegovy weight management services to “one weight loss patient…per month” due to “disgraceful” purchasing quotas for the jab, while an online pharmacy was able to purchase at least 10 times more stock.

At the time, manufacturer Novo Nordisk told C+D that that supply would “continue to be constrained”.

In October, the medicines watchdog also warned that counterfeit semaglutide Ozempic injection pens had been intercepted at two UK wholesalers, revealing the following month that insulin found in fake Ozempic and Saxenda jabs had led to patients being hospitalised with hypoglycaemic shock.

And in June, the government and the Medicines and Healthcare products Regulatory Agency (MHRA) included semaglutide on the list of medications that wholesalers are prevented from exporting or hoarding in an attempt to tackle shortages.

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