GLP-1 agonists induce weight loss and alleviate headache in idiopathic intracranial hypertension

In obese patients with idiopathic intracranial hypertension (IIH), GLP-1 agonists were found to be a safe and effective treatment option for achieving significant weight loss. The therapy was also associated with favourable headache outcomes, possibly through an indirect effect of weight loss as well as a direct effect on intracranial pressure.

IIH is considered an obesity-related disorder, mostly occurring in young obese women. Glucagon-like peptide 1 (GLP-1) agonists (liraglutide, semaglutide) represent an attractive treatment option for sustained weight loss and are indicated for patients with a BMI ≥30 or a BMI of 27–30 with comorbidities (dysglycaemia, hypertension, dyslipidaemia, obstructive sleep apnoea). Dr Nik Krajnc (Medical University of Vienna, Austria) explained that, as GLP-1 agonists represent an effective treatment option for sustained weight loss, they could therefore, indirectly or perhaps also directly, positively affect headache in IIH [1].

In an open-label, single-centre, case-control pilot study, study participants had IIH and a BMI ≥30. They were offered a GLP-1 agonist besides usual-care weight management (UCWM) in the form of dietary counselling and non-supervised physical exercise. IIH medication was continued independently. Controls were age-, sex- and BMI-matched IIH patients electing UCWM only. The primary endpoint was percentage weight loss at 6 months. Non-weight-related outcomes included headache, ophthalmological parameters, and safety.

A total of 39 IIH patients were included in the analysis. Their mean age was 33.6 years, 92.3% were women, and median BMI was 36.3 (IQR 31.4–38.3). Of these 39 participants, 13 received GLP-1 agonists (11 semaglutide, 2 liraglutide), while 26 received UCWM by choice. After 6 months, mean weight loss was higher in the GLP-1 agonist group (-12.0% vs -2.8%; P<0.003). A higher proportion of patients in the GLP-1 agonist group lost ≥10% weight (38.5% vs 0.0% at 3 months; P=0.001; 69.2% vs 4.0% at 6 months; P<0.001). The median reduction in the number of monthly headache days (MHD) was higher in the GLP-1 agonist group (see Figure; -3 vs 0 at 3 months; P=0.003; -4 vs 0 at 6 months; P=0.02). The 50% responder rate was higher in the GLP-1 agonist group (see Figure; β=-0.20, 95% CI -0.37 to -0.03; P=0.03). The study period was too short to prove an effect on visual outcomes.

GLP-1 agonist treatment was overall safe and well tolerated. There were 9 patients in the GLP-1 agonist group who reported at least 1 adverse event. Most common were nausea (n=9; 69.2%), decreased appetite (n=2; 15.4%), and increased lipase (n=3; 23.1%). There were no serious adverse events and no elevation of liver/pancreatic enzymes was observed. No adverse event led to premature discontinuation of treatment.

Figure: Change in monthly headache days (a) and 50% responder rate (b) [1]



GLP-1-RA, glucagon-like peptide 1 receptor agonists; UCWM, usual-care weight management

1. Krajnc N, et al. Treatment with GLP-1 agonists in patients with idiopathic intracranial hypertension: a pilot case-control study. EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.

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Posted on 7 September, 20237 September, 2023