NICE Guidelines

What changed:

• August 2026: NICE reviewed treatments for self-limited epilepsy with centrotemporal spikes following the UK licensing of sultiame in January 2025. No new evidence was found and an expert working group agreed the changes. Recommendation 6.4.3 now says consider sultiame monotherapy if first-line treatments are unsuccessful, and that sultiame should only be prescribed by, or on the advice of, a paediatric epilepsy specialist. Recommendation 6.4.4 says if sultiame is unsuccessful or unsuitable, consider carbamazepine, oxcarbazepine or zonisamide as monotherapy. Sultiame no longer carries an off-label note.
• January 2025: Recommendations on valproate and topiramate amended in line with MHRA guidance.

What changed:

• April 2026: Reviewed evidence for referral for ovarian cancer, endometrial cancer and non-site-specific weight loss. New and updated recommendations on ovarian cancer age and serum CA125 thresholds (recommendations 1.5.6 to 1.5.9, and 1.5.11), endometrial cancer (recommendations 1.5.12, 1.5.14 and 1.5.15), and non-site-specific weight loss (recommendation 1.13.2).
• January 2026: Removed an incorrect recommendation on blood tests for myeloma.
• May 2025: Amended recommendations 1.2.1 and 1.2.7: now recommends a suspected cancer pathway referral (rather than urgent direct access endoscopy) for people with symptoms indicating a 3% or more probability of oesophageal or stomach cancer.
• April 2025: Amended blood test recommendations for myeloma in response to NHS England National Cancer Programme reviews on earlier diagnosis.

What changed:

• August 2026 (minor change): NICE reinstated the off-label note on recommendation 1.5.25, which had been removed in error in November 2024.
• April 2026: Recommendation 1.8.4 amended and new recommendation 1.8.5 added on unscheduled vaginal bleeding while taking systemic HRT, aligning with the April 2026 update to NICE's suspected cancer guideline (NG12). NICE says vaginal bleeding is a common side effect during the first 6 months of taking systemic HRT or within any 3 months of changing the dose or preparation, and advises people to seek medical help promptly if unscheduled bleeding occurs beyond these timeframes. NICE notes limited evidence on unscheduled bleeding on sequential or continuous HRT and signposts the British Menopause Society guidance on management of unscheduled bleeding on HRT.

What changed:

• March 2026 (new guideline): Partially updates and replaces CG156 (2013). NICE has removed the recommendations on hypothalamic-pituitary-ovarian dysfunction, predominantly polycystic ovary syndrome, because it is developing a separate guideline on PCOS. New and updated recommendations, marked [2026], include endometriosis (section 1.36) and fertility preservation for medical indications.
• IVF add-ons: NICE says do not offer endometrial scratch as a pre-treatment to improve the outcome of IVF (1.40.1), and do not offer endometrial receptivity testing as a treatment add-on for embryo transfer (1.41.1).

What changed:

• February 2026: NICE added recommendation 1.2.11: offer advice on healthy living, in line with NHS information on healthy living, to people who have raised blood pressure but have not been diagnosed with hypertension.
• Under review: NICE says it is monitoring ongoing research on the response to antihypertensive drugs in different ethnic groups, will check the evidence when published, and will then decide whether to update the guideline.
• Treatment and monitoring: No changes to treatment or monitoring recommendations in this update.

What changed:

• September 2026 (minor change): NICE amended the descriptions of the eGFR ranges in recommendations 1.18.1 and 1.18.2 to clarify when each recommendation applies. The recommendations themselves are unchanged.
• February 2026: NICE reviewed the evidence on medicines for type 2 diabetes in adults with no relevant comorbidities and in adults with common comorbidities, and made new and updated recommendations on metformin, SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas and pioglitazone. Recommendations are made at drug class level. For adults with no relevant comorbidity, NICE now recommends offering modified-release metformin and an SGLT-2 inhibitor as initial treatment (1.13.1). Medicines are introduced one at a time, starting with metformin and adding the SGLT-2 inhibitor once metformin is at the maximum tolerated dose (1.20.2). If metformin is contraindicated or not tolerated, NICE recommends SGLT-2 inhibitor monotherapy (1.13.2).
• Comorbidity pathways: For adults with established atherosclerotic cardiovascular disease, NICE recommends offering modified-release metformin, an SGLT-2 inhibitor and subcutaneous semaglutide up to 1 mg once a week (1.15.1). For early-onset type 2 diabetes, diagnosed before age 40, NICE recommends metformin and an SGLT-2 inhibitor and says consider adding a GLP-1 receptor agonist or tirzepatide (1.16.1). Separate initial pathways cover heart failure, obesity, chronic kidney disease by eGFR band (1.18.1 to 1.18.3) and frailty or multimorbidity. NICE states that at February 2026 the GLP-1 receptor agonist recommendations cover liraglutide, dulaglutide and semaglutide only.
• Other changes in the February 2026 update: HbA1c target recommendations now refer to an "initial medication regimen" rather than a "single drug". Insulin recommendations were amended in the context of product withdrawals and brand shortages, including advice to use the least expensive option, including biosimilars, where basal insulin types and regimens are equally suitable (1.34.1). Links to the NHS Type 2 Diabetes Path to Remission Programme were added throughout. Terminology changed to "living with overweight" and "healthy living".

What changed:

• September 2026 (minor change): Non-alcoholic fatty liver disease has been renamed metabolic dysfunction-associated steatotic liver disease in the sections on surgical interventions, dietary approaches, and discussing results and referral for adults.
• March 2026 (minor change): References to withdrawn Public Health England documents removed or replaced.
• January 2026: Recommendations 1.10.5, 1.10.10 and 1.10.11 amended to clarify that waist-to-height ratios should only be used to classify the degree of central adiposity in children and young people aged 5 years and over.
• 2025 minor changes: February: references to weight-loss medicines changed to weight-management medicines. March: links added to the NHS BMI calculator for adults and the NHS waist-to-height ratio calculator for children and young people aged 5 and over. April: "UKVRN registered nutritionist administered by the Association for Nutrition" changed to "registered nutritionist".
• January 2025 (new guideline): Major consolidation with new evidence-reviewed recommendations on prevention in schools/nurseries, general principles of care, identification/assessment/referral, behavioural interventions, dietary advice, advice for ethnic minority backgrounds, multidisciplinary teams for children, and raising awareness of interventions. Emphasis on respectful, non-judgemental, person-centred care.

What changed:

• January 2026 (minor change): Recommendations amended to refer to "learning disabilities" rather than "learning difficulties".
• November 2025 (new guideline): The sepsis guideline covering all ages has been split into three guidelines. NICE reviewed the evidence on rapid antigen and PCR tests, indicators of organ hypoperfusion, intravenous fluid therapy, vasopressors and risk factors for sepsis. The initial IV fluid bolus is now 250 ml, ideally over 10 to 15 minutes (1.8.6), reduced from 500 ml in the 2016 recommendation. New recommendations cover starting vasopressors peripherally where central access is not available (1.8.11, 1.8.13) and finding and controlling the source of infection. NEWS2 is used within clinical context, including transfer by ambulance for consecutive NEWS2 scores of 5 or above (1.7.4).
• Update in progress: NICE says it is updating this guideline on the use of procalcitonin tests.

What changed:

• January 2026 (minor change): Recommendations amended to refer to "learning disabilities" rather than "learning difficulties".
• November 2025 (new guideline): Split from the original all-ages sepsis guideline (NG51, 2016) into a dedicated guideline for children and young people under 16, covering recognition, early assessment, initial treatment and escalation of care.
• Update in progress: NICE says it is updating this guideline on the national paediatric early warning score (PEWS).

What changed:

• January 2026 (minor change): Recommendations amended to refer to "learning disabilities" rather than "learning difficulties".
• November 2025 (new guideline): Split from the original all-ages sepsis guideline (NG51, 2016) into a dedicated guideline for pregnancy and the postpartum period, covering recognition and early assessment, initial treatment, escalating care, finding and controlling the source of infection, early monitoring, information and support, and training and education.
• Update in progress: NICE says it is updating this guideline on the use of the maternity early warning score (MEWS).

What changed:

• December 2025 (minor change): The rationale for recommendation 1.7.2 was amended to clarify NICE's advice on prescribing angiotensin receptor-neprilysin inhibitors (ARNIs) by primary care prescribers. The recommendation says primary care prescribers should consider seeking advice from a heart failure specialist before starting someone on an ARNI.
• October 2025 (minor change): The rationale for recommendation 1.7.10 was amended to clarify that a 12-lead ECG should be carried out to assess heart rhythm, heart rate and conduction before deciding whether to prescribe a beta-blocker.
• September 2025: NICE reviewed the evidence on treating and monitoring heart failure with reduced, mildly reduced and preserved ejection fraction. Recommendations with reviewed evidence are marked [2025]. For preserved ejection fraction, NICE says consider a mineralocorticoid receptor antagonist and an SGLT2 inhibitor (1.5.4). For mildly reduced ejection fraction, consider an ACE inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor (1.5.1), with an ARB if an ACE inhibitor is not tolerated (1.5.2). See TA1182 (August 2026) for finerenone as an MRA option in preserved and mildly reduced ejection fraction.

What changed:

• January 2026 (minor change): Table 1 and recommendation 1.8.2 updated to reflect the January 2024 MHRA advice on the use of fluoroquinolone antibiotics.
• November 2025 (minor change): Links updated to the three new suspected sepsis guidelines (NG253, NG254, NG255).
• September 2025 (new guideline): Amalgamates and replaces the antimicrobial prescribing guidelines on community-acquired pneumonia (NG138) and hospital-acquired pneumonia (NG139), both from 2019, and partially updates and replaces CG191 (2014). Antibiotic course length is reduced from 5 days to 3 days for babies and children aged 3 months (corrected gestational age) to 11 years with non-severe community-acquired pneumonia without complications or underlying disease. New recommendations cover corticosteroids for adults in hospital with high-severity community-acquired pneumonia.

What changed:

• November 2025 (minor change): Link in recommendation 1.1.1 updated to NICE's guideline on suspected sepsis in people aged 16 or over (NG253).
• September 2025: Removed the section on clinical diagnosis of community-acquired pneumonia in primary care (this content is now covered by the new NG250 pneumonia guideline).

What changed:

• May 2025 (minor change): Recommendation 1.2.1 changed to clarify that people in a hospital inpatient setting or a residential care setting do not need to meet any other criteria for a comprehensive falls assessment.
• April 2025 (new guideline): Updates and replaces CG161 (2013). Key changes: scope expanded to include people aged 50–64 with conditions increasing fall risk (e.g. arthritis, dementia, diabetes, Parkinson's, stroke, learning disability). Recommends against using falls risk prediction tools (evidence shows insufficient accuracy when used alone). Emphasises opportunistic questioning about falls at routine appointments. New recommendations on comprehensive falls assessment, home hazard assessment using validated tools, and evidence-based exercise programmes. Applies across community, hospital, and care home settings.

What changed:

• January 2025 (new guideline): NICE's guideline on identifying, assessing and managing gambling-related harms in children, young people and adults. NICE says consider asking people about gambling, even if they have no obvious risk factors, when asking about smoking, alcohol or other substance use, for example as part of a holistic assessment or health check or when registering with a GP (1.1.2). NICE says ask people about gambling in situations of increased risk, including mental health problems, medicines that affect impulse control, alcohol or substance use problems, homelessness and financial concerns (1.1.3), using direct questions such as "Do you gamble?" (1.1.6). Recommendations cover case identification, initial support, referral and assessment.

What changed:

• July 2025 (minor change): Wording clarified on the BMI thresholds referenced in recommendations 1.2.9 and 1.2.10.
• April 2025 (minor change): Recommendation 1.2.9 changed to highlight that a BMI of 30 kg/m2 or over is one of several risk factors for gestational diabetes.
• January 2025 (new guideline): Updates and replaces NICE's guideline on maternal and child nutrition (PH11, 2008) and the recommendations on weight management during pregnancy from PH27 (2010). Covers nutrition and weight management in pregnancy and nutrition in children up to 5 years, including vitamin supplementation (folic acid and vitamin D), breastfeeding and formula feeding, and introducing solid foods.

What changed:

• April 2026 (new guidance, early-use assessment): ArtiQ.Spiro can be used in the NHS during the 3-year evidence generation period as an option in primary care and community diagnostic centres. The evidence includes a UK-based randomised controlled trial using real-world evidence from primary care, reviewed by primary care healthcare professionals. NICE says algorithm outputs may support healthcare professionals to make diagnoses but do not replace clinical judgement or the need for a clinical assessment.
• More research needed: EasyOne Connect, GoSpiro and LungHealth cannot be recommended for NHS use until more evidence is available.

What changed:

• March 2026 (update): NICE updated the "what evidence generation is needed" section, added section 3.19 to reflect the updated evidence generation plan, and updated the information on spectrophotometry in section 3.9. The recommendations are unchanged.
• May 2025 (new guidance, early value assessment): DERM (Deep Ensemble for Recognition of Malignancy) can be used as an option within NHS teledermatology services during the 3-year evidence generation period. NICE notes the evidence is mostly for skin lesions in people with white skin. Conditions of use include a healthcare professional review for people with black or brown skin, regular monitoring of DERM's performance to maintain accuracy, and additional protocols when necessary, such as a national governance framework to ensure local oversight.

What changed:

• February 2026 (new guidance): CardioMEMS HF System can be used as an option for remote monitoring of NYHA class 3 chronic heart failure in adults at risk of hospitalisation who are able to use the technology, with the help of a carer if necessary, and willing to adjust medication as directed. Evidence from economic modelling shows CardioMEMS is likely to be cost effective. More research is needed on the Cordella Pulmonary Artery Sensor System and the Cordella Heart Failure System before they can be funded by the NHS.

What changed:

• February 2026: COPDPredict removed from recommendation 1.1 because it is no longer available to the NHS; the company, NEPeSMO, is no longer trading.
• Earlier removals: Active+me REMOTE was removed in September 2025 (Aseptika Ltd no longer trading) and Lenus COPD Support Service in February 2025 (Lenus Health no longer trading).
• Current recommendation: Four digital technologies can be used in the NHS during the 3-year evidence generation period: Clinitouch, COPDhub, Luscii and myCOPD. More research is needed on the standalone Doccla WellGuide patient app. NICE notes that 23.9% of people are readmitted within 30 days of discharge and 43.2% within 90 days.

What changed:

• January 2026 (new guidance, early value assessment): Eight digital technologies can be used in the NHS during the 3-year evidence generation period: getUBetter, Good Boost, Hinge Health, Joint Academy, Phio Engage, re.flex, Sword Thrive and TrackActive Me. Clinical trial evidence is limited but suggests these technologies improve physical function and reduce pain and stiffness, and NICE says their use may slow disease progression. More research is needed on Pathway Through Arthritis.

What changed:

• January 2026 (new guidance, early value assessment): Overcoming Bulimia Online can be used in the NHS during the 2-year evidence generation period for adults with binge eating disorder, bulimia nervosa, OSFED or disordered eating with similar features. It should only be used after an initial eating disorder assessment in primary care or further assessment by specialist eating disorder services, and alongside usual waiting list care such as regular check-ins and routine physical monitoring. NICE says self-help is not suitable for people with any form of anorexia nervosa. Evidence showed fewer binge eating episodes and less severe symptoms than usual waiting list care. More research is needed on Digital CBTe and Worth Warrior.

What changed:

• December 2025 (new guidance, early value assessment): Seven digital technologies can be used in the NHS during the 3-year evidence generation period, after a trained healthcare professional has assessed that the technology is suitable: Activate Your Heart, D REACH-HF, Digital Heart Manual, Gro Health HeartBuddy, KiActiv, myHeart and Pumping Marvellous Cardiac Rehab Platform. More research is needed on five further platforms: Beat Better, Datos Health, Get Ready, Luscii vitals and R Plus Health.

What changed:

• July 2025 (new guidance, early value assessment): Limbic Access and Wysa Digital Referral Assistant can be used in the NHS for people aged 16 and over during the 3-year evidence generation period. NICE states that Limbic Access is currently used by about 40% of NHS Talking Therapies services. Censeo Digital was removed from the guidance in July 2025. No recommendation was made for AskFirst because there was no information to support its inclusion.

What changed:

• May 2025 (new guidance, early value assessment): ORBIT recommended for use alongside standard care in the NHS during the evidence generation period (about 3 years) for children and young people aged 9–17 with chronic tic disorders and Tourette syndrome. Clinical evidence suggests ORBIT may reduce tic severity and improve everyday functioning. Neupulse could not be recommended in the final guidance because it does not yet have appropriate regulatory approval (CE/UKCA marking expected in 2026).

What changed:

• April 2025 (new guidance, late-stage assessment): The clinical evidence on different slide sheet features is limited and of poor quality. Key findings: washable slide sheets may save money compared with disposable or single-patient-use sheets, but only if an effective laundry system is in place. Slide sheets that remain under the person (in situ) may save money and have benefits for both the carer and patient when used for longer periods in the community.

What changed:

• November 2025 (new quality standard): Aligned with the new NG253 sepsis guideline.

What changed:

• October 2025: Changes made to align this quality standard with NICE's guideline on rehabilitation for chronic neurological disorders. The May 2023 update had previously aligned it with the updated NICE head injury guideline.

What changed:

• September 2025: Statement 3, on medication for chronic heart failure with reduced ejection fraction, updated to reflect the updated NICE guideline on chronic heart failure in adults (NG106). The statement now reads: adults with newly diagnosed and pre-existing chronic heart failure with reduced ejection fraction receive all appropriate medication at optimal tolerated doses.

What changed:

• September 2025: Updated and replaces the original quality standard on pneumonia in adults (2016), following publication of NICE's pneumonia guideline (NG250). The quality standard was previously called pneumonia in adults.

What changed:

• August 2025 (updated): NICE updated this quality standard, consolidating the earlier standards on overweight and obesity; statements are marked [2016, updated 2025] or [new 2025]. The eight statements cover: at least annual recording of BMI, and waist-to-height ratio where BMI is below 35 kg/m2, for adults with a long-term condition; opportunistic recording of BMI for children and young people over 2; support for people with a learning disability to access overweight and obesity management services; an up-to-date local list of overweight and obesity management interventions and services; sources of information for people identified as living with overweight, obesity or central adiposity; wraparound care focused on diet, nutrition and physical activity for people prescribed weight-management medicines; support for people stopping weight-management medicines or completing a behavioural intervention; and at least annual shared-care follow-up between specialist weight management services and primary care for adults discharged from bariatric surgery.

What changed:

• 2025 update: All five statements are updated or new in 2025. General practices use a systematic strategy to identify adults likely to be at high risk of cardiovascular disease [new 2025]. Adults with a 10-year cardiovascular risk of 10% or more receive tailored diet and lifestyle advice within 3 months of their risk score being recorded. Adults with a 10-year risk of 10% or more are prescribed a high-intensity statin, or other lipid-lowering treatment if a high-intensity statin is contraindicated or not tolerated. Adults starting or changing lipid-lowering treatment have a full lipid profile and liver transaminases measured at 2 to 3 months. Adults with cardiovascular disease have an LDL cholesterol level of 2.0 mmol per litre or less, or a non-HDL cholesterol level of 2.6 mmol per litre or less [new 2025].

What changed:

• April 2025: Updated to align with NICE's falls guideline (NG249). Previously called falls in older people; the scope now includes people aged 50 to 64 with one or more factors that could increase their risk of falls. Statements 1 to 3 are updated: people are asked about the details of any falls when they attend appointments or assessments in community or hospital settings; those meeting the criteria have a comprehensive falls assessment; and those needing comprehensive falls management have tailored interventions that address their individual risk factors. Statements 7 to 9 have been removed.

What changed:

• December 2023 (published): Updated and replaced the quality standards on epilepsy in adults (QS26) and epilepsy in children and young people (QS27), both from 2013, to align with NICE's epilepsies guideline (NG217). NICE states the parent guideline is being reviewed in light of the MHRA valproate safety alert and that this quality standard will be reviewed to consider whether an update is needed. The parent guideline has since been amended in January 2025 (valproate and topiramate, in line with MHRA guidance) and August 2026 (sultiame).

What changed:

• September 2025: Source guidance for statement 3, on antibiotic course length, updated to reflect NICE's pneumonia guideline (NG250).
• January 2024: Definitions and references in statements 4 to 7 updated to reflect NHS England's updated guidance on virtual ward care for people with acute respiratory infection.
• October 2023 (published): Aligned with NICE's guideline on suspected acute respiratory infection in over 16s (NG237). The seven statements cover a documented assessment of symptoms and signs at first presentation; no routine antimicrobial prescribing based only on a remote assessment; a 5-day antibiotic course, or 5 to 10 days if phenoxymethylpenicillin is prescribed for acute sore throat; and four statements on acute respiratory infection virtual wards, covering information for patients, a multidisciplinary team led by a named consultant practitioner or GP, supported self-management with a self-escalation plan, and a discharge summary shared with the GP.

What changed:

• August 2026 (new technology appraisal): Finerenone can be used, within its marketing authorisation, as an option to treat symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults. The marketing authorisation covers left ventricular ejection fraction of 40% or above. NICE defines preserved ejection fraction as 50% or above and mildly reduced as 41 to 49%.
• Position within NG106: Finerenone sits within NG106's existing recommendation to consider a mineralocorticoid receptor antagonist in preserved and mildly reduced ejection fraction, which the committee understood may include steroidal MRAs such as spironolactone or eplerenone and non-steroidal MRAs such as finerenone. Steroidal and non-steroidal MRAs would not be used together. Clinical experts told the committee that steroidal MRAs are often not started or not well tolerated in this population, and that finerenone has a lower risk of anti-androgenic side effects and is more likely to be suitable for people with comorbidities such as hypotension or chronic kidney disease. The risk of hyperkalaemia with finerenone is likely similar to spironolactone but may be slightly lower.
• Finerenone was not directly compared with spironolactone. NICE describes the indirect comparison and real-world analyses as uncertain, so it is positioned as an alternative rather than an established equivalent.
• Funding: Finerenone must be funded in England within 90 days of final publication of the guidance.

What changed:

• 30 June 2026 (new appraisal): Atogepant recommended for acute migraine treatment, evaluated through NICE's cost-comparison process against rimegepant, the usual acute treatment at this point in the pathway.
• Atogepant has not been directly compared with rimegepant in a clinical trial. An indirect comparison suggests similar pain reduction at 2 hours, though the result is uncertain. Clinical expert feedback supports using the two interchangeably, given their similar mechanism and administration.
• NICE advises prescribers to use whichever of atogepant and rimegepant is least expensive, taking account of administration costs, dosage and commercial arrangements.
• Atogepant must be funded in England within 30 days of publication, faster than the usual 90-day window because of the cost-comparison route. In Wales, funding is required within 60 days of the first publication of the final draft guidance.

What changed:

• 24 June 2026: Administrative update only. Recommendation 1.1 and the pricing sections were revised to remove reference to the company's commercial arrangement and update the list price to £45.36 per 28-pack, excluding VAT. The clinical eligibility criteria are unchanged since the original recommendation in April 2021.

What changed:

• 24 June 2026 (new appraisal): Seladelpar recommended as a second-line option after UDCA, alongside the existing options of obeticholic acid and elafibranor. The committee noted seladelpar may be of particular benefit for people with pruritus, since obeticholic acid carries a risk of worsening itch.
• The recommendation is based on the RESPONSE trial of 193 people with an inadequate response to, or intolerance of, UDCA. At 12 months, 61.7% of people taking seladelpar had a composite biochemical response (improved liver enzymes), compared with 20% taking placebo, and pruritus scores improved significantly more with seladelpar than placebo.
• Seladelpar has not been directly compared with obeticholic acid or elafibranor in a clinical trial. Indirect comparisons suggest it may reduce itch more than obeticholic acid, though comparative effectiveness against elafibranor remains uncertain.
• Seladelpar can only be used if the company provides it under the agreed commercial arrangement. It must be funded in England within 90 days of publication.

What changed:

• June 2026 (new appraisal): Mepolizumab can be used as an add-on maintenance treatment option for uncontrolled COPD with raised blood eosinophils in adults having triple therapy (inhaled corticosteroid, LABA and LAMA). NICE defines uncontrolled COPD as 1 or more severe exacerbations or 2 or more moderate exacerbations in the previous 12 months, and raised blood eosinophils as 0.3 x 10⁹ cells per litre or more (300 cells per microlitre or more).
• Evidence: The committee considered three trials: MATINEE, METREX and METREO. In MATINEE (mepolizumab plus standard care n=403, placebo plus standard care n=401), the annualised rate of moderate or severe exacerbations up to 104 weeks was reduced with mepolizumab, rate ratio 0.79 (95% CI 0.66 to 0.94).
• Stopping rule: NICE says assess response at 12 months and stop mepolizumab if, compared with the 12 months before starting it, the number of severe exacerbations is higher, or is the same and the number of moderate exacerbations is higher (1.2).
• Funding and setting: A commercial arrangement is in place and mepolizumab must be funded in England within 90 days of publication. The committee heard that drug monitoring and the stop-or-continue assessment would likely be managed in primary care, while prescribing in secondary care is required for the commercial arrangement to apply.

What changed:

• May 2026 (new technology appraisal): Semaglutide is recommended, up to 2.4 mg once weekly alongside a reduced-calorie diet and increased physical activity, as an option for reducing the risk of major adverse cardiovascular events in adults with established cardiovascular disease and a BMI of 27 kg/m² or more. Established cardiovascular disease means a previous myocardial infarction, a previous ischaemic or haemorrhagic stroke, or symptomatic peripheral arterial disease (intermittent claudication with a resting ankle brachial index below 0.85, or previous revascularisation or amputation because of atherosclerotic disease). A diagnosis of diabetes is not required. NICE does not specify the treatment setting, so initiation is a local commissioning decision. Evidence comes from the SELECT trial. Semaglutide can only be used if the company provides it according to the commercial arrangement, and must be funded in England within 90 days of publication.

What changed:

• April 2026 (partial review of TA599): Sodium zirconium cyclosilicate recommended as an option for treating hyperkalaemia in adults only if used: in emergency care for acute life-threatening hyperkalaemia alongside standard care; or for persistent hyperkalaemia in people with CKD stage 3b to 5 or heart failure who have a confirmed serum potassium level of at least 5.5 mmol/litre and who, because of hyperkalaemia, are not taking an optimised dosage of a RAAS inhibitor and are not on dialysis. The key change from TA599 is the lowering of the serum potassium threshold from 6.0 mmol/litre to 5.5 mmol/litre, broadening the eligible population.

What changed:

• March 2026 (new appraisal): Fezolinetant can be used as an option to treat moderate to severe vasomotor symptoms associated with menopause when hormone replacement therapy is unsuitable (1.1). It must be funded in England within 90 days of final publication.
• Exclusions and monitoring: People having treatment for breast cancer or other oestrogen-dependent cancers are not included in the marketing authorisation, so NICE made no recommendation for this group. For people who have had these cancers and are no longer having treatment, NICE says any decision to use fezolinetant should be based on an individual risk assessment. NICE notes fezolinetant is not recommended for people with liver disease, and that the MHRA marketing authorisation requires liver blood tests before treatment, monthly for the first 3 months, then periodically at the clinician's discretion.
• Comparators and setting: Fezolinetant has not been directly compared with non-hormonal treatments; indirect comparisons suggest similar effectiveness but this is uncertain. The committee concluded it could be prescribed in primary care, in primary care with advice and guidance from secondary care, or in secondary care.