GLP-1 Agonists May Help Reduce Use of Acetazolamide in IIH

While GLP-1 agonists are increasingly used for the treatment of obesity, they may have a similarly increasingly important role in the treatment of idiopathic intracranial hypertension as well, study shows. Click image to enlarge. The neurological disorder idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without a primary pathology. The condition predominantly affects obese women of childbearing age, and a weight loss plan is the recommended first step for treatment. The most common first-line medical treatment is acetazolamide to reduce cerebrospinal fluid production. Recently, glucagon-like peptide 1 (GLP-1) agonists have garnered interest for IIH management due to their weight reduction and potential cerebrospinal fluid production-decreasing effects. A recent study in Eye evaluated this popular drug’s effect on the ocular parameters of IIH. While the researchers found no significant differences were found in the parameters over a 12-month period, their results also showed a trend of BMI reduction and possible acetazolamide dose reduction following GLP-1 initiation.A retrospective cohort study was conducted using data from 79 IIH patients. 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. While the study did not include follow-up ICP measurements, the reduction in the Frisen grade and retinal nerve fiber layer (RNFL) thickness served as surrogate markers for ICP reduction.There was a significant difference in the baseline BMI between the two groups, with the acetazolamide group having a mean BMI of 32, compared with 38 in the GLP-1 agonist group. This difference in BMI remained significant throughout follow-up, as post-treatment mean BMI in the acetazolamide group was 31, while the post-treatment GLP-1 agonist group had a mean BMI of 37.No significant differences were found in any of the parameters: papilledema grade, best corrected visual acuity, visual field or OCT RNFL thickness improvements over a 12-month period. “In this case, it is noteworthy that the GLP-1 agonist group had no worse visual outcomes compared to the acetazolamide monotherapy group across all primary outcome measures despite the increased risk due to their higher baseline BMI,” the researchers wrote in their paper.Seven of the 11 patients in the combined therapy group completed the full year of follow-up data. The study noted a reduction in the dosage of acetazolamide, which was temporally correlated with the introduction of GLP-1 agonist therapy.This study had several limitations to consider, including a small sample size and a relatively short follow-up period, both potentially influencing the study’s ability to derive substantial statistical findings. Due to the retrospective nature of the study, the researchers could not determine whether the reduction in BMI seen in the GLP-1 group was the primary driver contributing to visual improvement, and they determined that future studies may want to further explore this relationship.“While GLP-1 agonists are increasingly used for the treatment of obesity, they may have a similarly increasingly important role in the treatment of IIH as well,” they concluded. Click here for the journal source.  Kravetz L, Leeman S, Regev T, et al. The effect of glucagon-like peptide-1 agonists on ocular parameters in idiopathic intracranial hypertension patients: a retrospective study. Eye (Lond). April 29, 2025. [Epub ahead of print].