Push to add semaglutide to PBS for schizophrenia patients

Semaglutide – the active component in weight-loss drugs such as Ozempic and Wegovy – is changing the weight-loss landscape and showing promise for a number of individuals who have previously struggled to lose weight.
 
But experts have expressed concerns that the price tag is creating unnecessary barriers for the most vulnerable patients who would significantly benefit from the medications, with advocates now calling for the drug to be made available under the Pharmaceutical Benefits Scheme (PBS) for people with schizophrenia.
 
Among those advocating for the change is psychiatrist Professor Dan Siskind.
 
He said a number of his patients who use semaglutide for weight loss are only able to do so with financial support from their families.
 
‘Many people with schizophrenia cannot afford to pay for this out of pocket,’ Professor Siskind said.
 
‘People with schizophrenia urgently need access to effective treatments for obesity, such as semaglutide. We would be strongly advocating for access to PBS listing for semaglutide for this population.’
 
Chair of RACGP Specific Interests Psychological Medicine Dr Cathy Andronis backs the call.
 
She told newsGP ensuring access for this cohort is especially important, ‘as this is a disadvantaged group of patients with many comorbidities’.
 
The push for the Federal Government to fund the drug follows the release of world-first research, which found semaglutide to be an effective weight-loss treatment for people with schizophrenia, without affecting their psychotic symptoms.
 
Published in Lancet Psychiatry, Professor Siskind led a research team at the University of Queensland who looked at semaglutide use in conjunction with clozapine, a drug considered to be the most efficacious antipsychotic for treatment-resistant schizophrenia. However, side effects of the antipsychotic are weight gain and metabolic dysfunction.
 
Thirty-one participants with schizophrenia who were prescribed clozapine for 18 weeks or more were randomly assigned to either the semaglutide or placebo groups, and at week 36, semaglutide was found to have yielded a 14% body weight reduction compared with 0.42% for those who received the placebo.
 
‘Semaglutide was found to be well tolerated, with no serious adverse events that were deemed to be related to the treatment,’ the authors said.
 
The study also didn’t find any adverse drug-to-drug interactions, or any impact on participants’ mental state.
 
In Australia, it is estimated that between 150,000 and 200,000 individuals have schizophrenia, equating to roughly one in 100 people. The condition comes with a 16-year life expectancy gap compared to the general population, largely driven by obesity-related illnesses.
 
Professor Siskind said the findings provide hope for patients prescribed clozapine, many of whom often stop taking the medication due to weight gain.
 
‘Antipsychotic medications are associated with high weight gain in patients, leading to poorer quality of life, shorter life expectancy, and poorer medication adherence,’ he said.
 
Dr Andronis echoed the sentiment that the research is ‘promising’ but noted the small cohort and limited focus of the study.
 
‘It is promising to see new effective treatment options for countering the metabolic effects of antipsychotics, as these have been a major blight in clinical management,’ she said.
 
‘The study is relatively small and focuses on clozapine, so we still need more evidence, particularly as most people with schizophrenia are treated with other medications that may be more obesogenic.’
 
According to Dr Andronis, treating obesity among patients with severe mental illness can be particularly challenging, as doctors are faced with a complex aetiology and presentation.
 
‘A biopsychosocial approach to care is critical because obesity is multi-factorial,’ she explained. 
 
‘Eating disorders are commonly coexisting with schizophrenia so holistic management is very important for better outcomes.
 
‘It requires an individualised approach, as well as good patient engagement to ensure safety and trust.’
 
Dr Andronis says this also goes for prescribing drugs such as semaglutide, which she notes have barriers that go beyond the cost of treatment.
 
‘Mode of administration and concurrent negative symptoms significantly affect compliance with treatment of schizophrenia patients,’ Dr Andronis said.
 
‘So good patient engagement and regular review is critical for maintaining engagement and compliance.’
 
To help support GPs in their delivery of care to patients with severe mental illness, the Psychological Medicine Chair said a multidisciplinary approach is needed.
 
‘More support from psychiatrists and endocrinologists would definitely be beneficial, as well as dietitian and physiotherapist referrals,’ she said.
 
Professor Siskind, who also works as a clinical psychiatrist in Brisbane, says he hopes the new research findings will help inform clinical treatment guidelines.
 
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