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Metabolic Peptides

Monthly recap

March 2026: SELECT cardiovascular implications crystallise across UK practice

February → March 2026 brief: SELECT 30-month follow-up reinforces 20% MACE reduction; UK NICE issues draft positioning for semaglutide in cardio-metabolic prevention.

By Metabolic Peptides Editorial TeamReviewed by Scientific Review PanelLast updated

SELECT 30-month follow-up

The American Heart Association late-breaker session in February released the SELECT 30-month follow-up — extending the original 39.8-month median follow-up published in NEJM 2023. The primary 3-point MACE hazard ratio continued to track at HR 0.80 (95% CI 0.72–0.90), with no attenuation of the treatment effect across the extension period. All-cause mortality showed a trend toward reduction (HR 0.87, p marginal) consistent with the broader cardiovascular benefit. For UK clinicians and researchers, the durability of the SELECT signal is now the dominant data point shaping NICE deliberations.

NICE draft positioning

NICE issued a draft positioning paper in late February proposing semaglutide 2.4 mg weekly as eligible for cardiovascular-prevention prescribing in adults with BMI ≥27 and established cardiovascular disease — independent of T2DM status. The draft is in consultation through May; the final guidance is expected mid-2026 and could meaningfully expand NHS-funded prescribing for the first time since Wegovy was added to the formulary.

Tirzepatide cardiovascular readouts approaching

Eli Lilly's investor day reaffirmed that SURMOUNT-MMO and SURPASS-CVOT are both inside their late-2026 readout windows. If both confirm a SELECT-like MACE signal, the dual-agonist class will arrive at the cardiovascular indication a quarter or two after the monoagonist landmark. That sequencing affects how UK guideline-writers may eventually distinguish between the molecules in cardio-metabolic indications.

Retatrutide MASH Phase 2

Eli Lilly disclosed preliminary signals from the retatrutide MASH Phase 2 trial: hepatic-fat fraction reductions consistent with the magnitude seen for semaglutide at 24 weeks, plus a directional improvement in fibrosis-related biomarkers (ELF score, PRO-C3) that hint at a glucagon-receptor-mediated hepatic effect over and above the incretin contribution. Full readout expected H2 2026.

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