NICE Technology Appraisal TA924
NICE Technology Appraisal TA924 recommends tirzepatide (Mounjaro) for treating Type 2 diabetes in adults in the NHS. The appraisal was published in 2023 following FDA and EMA approvals. NICE positioned tirzepatide as an alternative to GLP-1 receptor agonists in the existing T2D treatment pathway, meaning it is not positioned as a first-line agent or as a replacement for SGLT2 inhibitors in patients with cardiovascular or renal comorbidities.
Under NHS practice, tirzepatide is typically considered third or fourth line — after lifestyle intervention, metformin, and a combination of oral agents. Injected agents (including GLP-1 RAs and tirzepatide) are reserved for patients who have not achieved adequate control on oral therapy. The appraisal noted the complexity of the T2D treatment pathway and the need for clinical judgement in patient selection.
Continuation criteria (important for clinical practice): NICE specified that tirzepatide should only be continued if the patient shows a beneficial metabolic response — defined as a reduction of at least 11 mmol/mol (1.0%) in HbA1c AND weight loss of at least 3% of initial body weight at 6 months. This is stricter than simple availability and ensures only responding patients continue long-term NHS treatment.
The recommendation is subject to a commercial arrangement between NICE and Eli Lilly regarding pricing. NICE noted that use in clinical practice may deviate from the strict criteria in some cases.
Ontology NICE Technology Appraisal TA924 [recommended_by] Tirzepatide NICE Technology Appraisal TA924 [guideline_for] Type 2 Diabetes NICE Technology Appraisal TA924 [relates] Semaglutide NICE Technology Appraisal TA924 [relates] ADA Standards of Care 2023-2024
Recommendations
- Recommended for: T2D adults as alternative to GLP-1 RAs; lower BMI thresholds for South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds
- Caution or not recommended for: First-line use; patients without response at 6 months (continuation criteria not met); patients with MTC history or MEN2
- Position relative to insulin: Alternative to insulin for some patients; not a replacement for insulin in advanced beta-cell failure
- Position relative to GLP-1 therapies: Positioned as alternative — same tier; superior glycaemic efficacy but same access/positioning constraints
- Position relative to SGLT2 therapies: SGLT2i remain preferred for CVD, heart failure, and CKD (established NICE guidance TA775, TA739); tirzepatide fills the GLP-1 RA niche
Connections
- Tirzepatide — recommended_by, [2023], source: NICE TA924
- Type 2 Diabetes — guideline_for, [2023]
- Semaglutide — relates (alternative agent same tier)
- ADA Standards of Care 2023-2024 — relates