Background: Liraglutide is a glucagon-like peptide analogue which was approved for use in children and young people as an option for managing obesity in December 20201. It is to be used in tier 3 services alongside a reduced-calorie diet and increased physical activity in children more than 12 years if they have a BMI SDS age-equivalent more than 30kg/m2 for adults. We describe our initial experiences of using liraglutide in a tier 3 paediatric obesity service in a group of patients who have not previously lost weight despite multidisciplinary team input.
Methods: 10 patients were commenced on liraglutide in a tertiary paediatric obesity service who had previously failed to successfully lose weight with multidisciplinary input, including psychology and dietetics. 7 patients were female. They ranged in age from 13 years 1 months to 17 years 11 months. Initial starting BMI SDS scores ranged from 3.11 – 4.36 (mean 3.86). The patients all had comorbidities; 1 patient had autistic spectrum disorder, 2 attention-deficit hyperactivity disorder, 1 learning difficulties, 1 hypertension and 1 non-alcoholic fatty liver disease. The initial starting dose of liraglutide used was 0.6mg and this was increased on a 2-weekly basis as tolerated up to a maximum dose of 3.0mg. All patients and their families were provided with training for administering liraglutide by a paediatric obesity clinical nurse specialist. Patients had BMI monitored regularly after commencing liraglutide and were reviewed for side effects.
Outcomes: 9 out of 10 patients who commenced liraglutide have continued on it but one patient stopped due to pre-existing mental health problems. Reports of gastro-intestinal side effects were frequent but felt to be tolerable and did not cause patients to discontinue treatment. The patients were taking between 1.8 – 3.0mg daily. 9 out of 10 patients had lost weight with mean BMI SDS decrease of 0.19 (range +0.07 to - 0.63) at between 3-6 months.
Discussion: These data represent early promising results for the effectiveness and tolerability of liraglutide in a clinical setting in adolescent patients who have not previously lost weight despite multidisciplinary team input. Therefore, liraglutide may be a useful weight loss intervention in paediatric clinical practice. Further follow-up is needed in order to assess longer term outcomes in these patients.
1. National Institute for Health and Clinical Excellence – Liraglutide for managing overweight and obesity technology appraisal guidance [TA664]. 9 December 2020
15 Sep 2022 - 17 Sep 2022