BACKGROUND: Idiopathic intracranial hypertension (IIH) is a neurological condition marked by elevated intracranial pressure (ICP) with no evident secondary cause, primarily affecting obese females of childbearing age. While acetazolamide is the standard medical therapy, weight loss is also considered a first-line treatment. Recently, glucagon-like peptide 1 (GLP-1) agonists have garnered interest for IIH management due to their weight reduction and potential CSF production-decreasing effects. This study evaluates the effect of GLP-1 agonists on ocular parameters of IIH.
METHODS: A retrospective cohort study was conducted using data from 79 IIH patients who met the modified Dandy criteria and were diagnosed between January 2016 and July 2023. All included patients received acetazolamide, while some received additional therapy with a GLP-1 agonist, either liraglutide or semaglutide. The acetazolamide monotherapy group was compared with the combined therapy group. Data on ocular parameters and BMI changes were collected from the Soroka Medical Center's electronic medical records. Patients with incomplete electronic documentation or with any history of invasive interventions were excluded from the study.
RESULTS: When comparing 68 patients on acetazolamide alone to 11 patients on combined therapy with acetazolamide and GLP-1 agonists, no significant differences were found in any of the parameters: papilledema grade, best corrected visual acuity (BCVA), visual field (VF) or OCT RNFL thickness improvements over a 12-month period. Seven of the 11 patients in the combined therapy group completed the full year of follow up data and were included in the secondary outcome analysis, which revealed a trend of BMI reduction and possible acetazolamide dose reduction following GLP-1 initiation.
CONCLUSION: This study suggests that GLP-1 agonists effectively reduce BMI, a major risk factor for IIH. Moreover, our analysis of seven patients from the combined therapy group suggests that GLP-1 agonists allow for a reduction in acetazolamide dosage in the treatment of IIH without changing the clinical outcome.