Potential therapeutic role of GLP-1 receptor agonists in Idiopathic intracranial hypertension: a systematic review and meta-analysis

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure (ICP) , often resulting in headaches and visual impairment. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), commonly used in the treatment of metabolic disorders, have emerged as potential therapeutic strategies for IIH. METHODS: We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up to July 2025, following PRISMA guidelines. Primary outcome was incidence of refractory IIH; secondary outcomes included visual function, headache-related measures, and BMI. Random-effects models were used to pool relative risks (RRs) and standardized mean differences (SMDs). RESULTS: Seven studies involving 11,973 participants were included. GLP-1RAs significantly reduced refractory IIH incidence (and the risk of papilledema (RR = 0.40, 95% CI: 0.22-0.72), as well as visual disturbances and blindness (RR = 0.51, 95% CI: 0.28-0.95). However, no significant improvements were observed in objective visual parameters, including visual acuity, visual field, or peripapillary retinal nerve fiber layer (pRNFL) thickness. GLP-1RA therapy was associated with reduced headache incidence (RR = 0.74, 95% CI: 0.54-1.00) and fewer monthly headache days (SMD = -0.77, 95% CI: -1.35 to -0.19). Changes in BMI were not significant (SMD = -0.06, 95% CI: -0.15 to 0.02). CONCLUSIONS: GLP-1RAs show promise as adjunctive therapies for IIH, offering improvements in refractory IIH, papilledema, and headache burden. Further large-scale randomized controlled trials are needed to confirm these findings.