Susan McGowan died on September 4.
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According to a report by the BBC on November 8, the 58-year-old’s death certificate listed her causes of death as multiple organ failure, septic shock and pancreatitis, with “the use of prescribed tirzepatide” – known by the brand name Mounjaro – listed as a contributing factor.
It is the first known death in the UK linked to glucagon-like peptide (GLP-1) receptor agonists, a new class of drug which mimics the action of GLP-1 – a naturally occurring gut hormone which is released after eating.
Their effect is to slow the digestion process, reduce cravings and make patients feel fuller.
Ozempic and Wegovy also belong to the GLP-1 category.
It is understood that Ms McGowan, who had worked as a nurse at University Hospital Monklands in Airdrie for more than 30 years, had purchased a prescription for Mounjaro via a registered online pharmacy.
It costs around £150 to £200 for a four-week supply.
The drug – in the form of its Mounjaro KwikPen device – was approved by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) in January this year as a safe treatment for adults with diabetes, and for weight management in patients with a BMI of 30-plus.
Since then, the Scottish Medicines Consortium – which advises whether drugs are cost-effective for the NHS – has recommended its use in diabetes management and for weight loss in adults with obesity plus another co-morbidity, such as cardiovascular disease or high blood pressure.
Friends say she struggled with her weight, but never had any other health concerns.
She had taken only two doses when she fell ill with severe stomach pains and was rushed to A&E. Her kidneys were failing, and she fell into a coma.
It is not the first time the alarm has been raised about patients obtaining GLP-1 drugs privately.
Back in June, the Society for Acute Medicine warned that doctors were treating “increasing numbers” of patients presenting with serious side effects after purchasing supplies online.
Dr Vicky Price, its president, said they were “seeing serious, life-threatening complications, including inflammation of the pancreas gland and alterations in blood salt levels in these patients who were not aware of the risk they were taking”.
In one case, an A&E doctor – speaking anonymously to the Chemist and Druggist news website – said they had treated a “young girl” who was “not at all” overweight but had arrived in the emergency department after developing starvation ketoacidosis – a life-threatening condition where chemicals known as ketones build up in the blood due to lack of food.
She had obtained a month’s supply of Wegovy online and “was really struggling to eat”, according to the doctor.
Doctors in A&E departments are seeing more cases of complications (Image: PA) Figures released this week indicate that between April 2023 and August 2024, a total of 16 patients were treated in A&E departments across NHS Greater Glasgow and Clyde and NHS Lanarkshire as a result of side effects from GLP-1 drugs.
In October, the MHRA reported that – as of May this year – 46 patients had been hospitalised after using them for weight loss, and more than 5,000 patients had experienced gastrointestinal reactions.
The crux of the problem is not necessarily the drugs themselves (no medicine is risk free), but the present shortcomings in regulation.
The General Pharmaceutical Council has said the sale of weight-loss medicines will be a key focus as it looks to beef up its regulatory approach to the online pharmacy market, which has more than doubled in size since the pandemic.
Previous analysis, published in the Pharmaceutical Journal, found that 22% of online pharmacy companies were in breach of at least one regulatory standard during inspections compared to just 2.6% of ‘bricks and mortar’ pharmacies.
Nonetheless, the safety profile of GLP-1 drugs will be under particular scrutiny amid plans to ramp up their use on the health service to tackle obesity.
UK Health Secretary Wes Streeting has already announced a deal with manufacturer, Lilly, to roll out Mounjaro on NHS England to around quarter of a million patients as part of a targeted trial designed to see whether it can help adults currently sick with weight-related conditions to return to work.
A major clinical trial has highlighted significant health benefits, beyond weight loss and diabetes management (Image: PA) The question, of course, is whether the benefits outweigh the risks.
Obesity itself makes people ill with diabetes, cancers – including breast and bowel – heart disease, strokes, liver and kidney disease, gallstones, and reduced fertility.
While a paper published yesterday in the Lancet cautioned that GLP-1 drugs should not be seen as a “silver bullet”, it noted that without action two thirds of adults in the US will be obese by 2050.
In May this year, the findings of the Select clinical trial – the largest study to date of semaglutide, the active ingredient in Wegovy and Ozempic – were presented at the European Congress on Obesity.
It found that the 17,600 participants (who were over 45, overweight or obese, but without diabetes) lost 10% of their bodyweight on average using Wegovy, compared to 1.5% for those on the placebo.
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Furthermore, Wegovy was associated with a 20% reduction in heart attacks, strokes and cardiovascular deaths – an effect that persisted even if patients did not lose weight.
While the rate of side effects was around 17% for the drug compared to 8% for the placebo, these were mostly mild: nausea, diarrhoea, vomiting and constipation.
Rates of acute pancreatitis were not elevated in the Wegovy group and rates of gallbladder disorders like gallstones were only slightly higher (2.8% vs 2.3%).
There are huge potential gains for population health.
But tragedies like the death of Ms McGowan are a reminder of the individual casualties of a weight loss dream that can turn into a nightmare.
