Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension

• Published in: Journal of headache and pain Vol. 24; no. 1; p. 89
• Main Authors: Krajnc, Nik, Itariu, Bianca, Macher, Stefan, Marik, Wolfgang, Harreiter, Jürgen, Michl, Martin, Novak, Klaus, Wöber, Christian, Pemp, Berthold, Bsteh, Gabriel
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 18.07.2023; Springer Nature B.V; BMC
• Subjects: Acetazolamide; Adult; Agonists; Body mass index; Body weight loss; Dosage; Female; Glucagon; Glucagon-Like Peptide 1; Glucagon-Like Peptide-1 Receptor - agonists; Headache; Headache - complications; Headaches; Humans; Hypertension; Idiopathic intracranial hypertension; Internal Medicine; Male; Medicine; Medicine & Public Health; Neurology; Pain Medicine; Pilot Projects; Pseudotumor Cerebri - complications; Pseudotumor Cerebri - drug therapy; Visual worsening; Weight control; Weight Loss; Headache; Glucagon-like peptide-1; Visual worsening; Idiopathic intracranial hypertension; Weight loss
• ISSN: 1129-2377; 1129-2369; 1129-2377
• DOI: 10.1186/s10194-023-01631-z

Background In idiopathic intracranial hypertension (IIH), sustained weight loss is the main pillar in modifying disease course, whereby glucagon-like peptide-1 receptor agonists (GLP-1-RAs) could present an attractive treatment option. Methods In this open-label, single-center, case–control pilot study, patients with IIH (pwIIH) and a body mass index (BMI) of ≥ 30 kg/m 2 were offered to receive a GLP-1-RA (semaglutide, liraglutide) in addition to the usual care weight management (UCWM). Patients electing for UCWM only served as a control group matched for age-, sex- and BMI (1:2 ratio). The primary endpoint was the percentage weight loss at six months (M6) compared to baseline. Secondary endpoints included the rate of patients with a weight loss of ≥ 10%, monthly headache days (MHD), the rate of patients with a ≥ 30% and ≥ 50% reduction in MHD, visual outcome parameters, and adverse events (AEs). Results We included 39 pwIIH (mean age 33.6 years [SD 8.0], 92.3% female, median BMI 36.3 kg/m 2 [IQR 31.4–38.3]), with 13 patients being treated with GLP-1-RAs. At M6, mean weight loss was significantly higher in the GLP-1-RA group (–12.0% [3.3] vs. –2.8% [4.7]; p  < 0.001). Accordingly, weight loss of ≥ 10% was more common in this group (69.2% vs. 4.0%; p  < 0.001). Median reduction in MHD was significantly higher in the GLP-1-RA group (–4 [–10.5, 0.5] vs. 0 [–3, 1]; p  = 0.02), and the 50% responder rate was 76.9% vs. 40.0% ( p  = 0.04). Visual outcome parameters did not change significantly from baseline to M6. Median reduction in acetazolamide dosage was significantly higher in the GLP-1-RA group (–16.5% [–50, 0] vs. 0% [–25, 50]; p  = 0.04). AEs were mild or moderate and attributed to gastrointestinal symptoms in 9/13 patients. None of the AEs led to premature treatment discontinuation. Conclusions This open-label, single-center pilot study suggests that GLP-1-RAs are an effective and safe treatment option for achieving significant weight loss with a favorable effect on headache, leading to reduced acetazolamide dosage in pwIIH. Graphical Abstract