Efficacy of Tirzepatide Dual GIP/GLP-1 Receptor Agonist in Patients With Idiopathic Intracranial Hypertension. A Real-World Propensity Score-Matched Study
Ahmed Y. Azzam, Muhammed Amir Essibayi, Nathan Farkas, Mohammed A. Azab, Mahmoud M. Morsy, Osman Elamin, Adam Elswedy, Ahmed Saad Al Zomia, Hammam A. Alotaibi, Ahmed Alamoud, Oday Atallah, Hana J. Abukhadijah, Adam A. Dmytriw, Amanda Baker, Deepak Khatri, Neil Haranhalli, David J. Altschul
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引用次数: 0
Abstract
Introduction
Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by elevated intracranial pressure (ICP), predominantly affecting obese women of reproductive age. While GLP-1 receptor agonists have shown promise in IIH management, the potential of dual GIP/GLP-1 receptor activation through tirzepatide remains unexplored. This study aimed to evaluate tirzepatide's efficacy as an adjunctive therapy in IIH management.
Methods
We conducted a retrospective cohort analysis using the TriNetX Global Health Research Network, analysing data through November 2024. Through propensity score matching, we compared 193 tirzepatide-exposed IIH patients with 193 controls receiving standard care. Primary outcomes included papilledema severity, visual function, headache frequency, and treatment resistance, monitored at multiple follow-up timepoints.
Results
Our analysis revealed significant improvements across all measured outcomes in the tirzepatide group. At 24 months, we observed a 68% reduction in papilledema risk (RR 0.320, 95% CI 0.189–0.542, p < 0.001), a 73.9% reduction in visual disturbance and blindness risk (RR 0.261, 95% CI 0.143–0.477, p < 0.001), and a 19.7% reduction in headache risk (RR 0.803, 95% CI 0.668–0.966, p = 0.019). The tirzepatide group demonstrated significant body-mass index reductions, reaching −1.147 kg/m2 (95% CI [−1.415, −0.879], p < 0.001) at 24 months compared to controls.
Conclusions
Our results demonstrate that tirzepatide, when used as an adjunctive therapy, provides significant therapeutic benefits in IIH management, particularly in improving papilledema and visual outcomes. Our findings suggest that dual GIP/GLP-1 receptor activation may offer advantages over traditional single-receptor therapies, potentially through enhanced metabolic regulation and direct effects on ICP dynamics.
特发性颅内高压(IIH)是一种以颅内压(ICP)升高为特征的神经系统疾病,主要影响育龄肥胖妇女。虽然GLP-1受体激动剂在IIH治疗中显示出前景,但通过替西肽激活GIP/GLP-1受体的潜力仍未被探索。本研究旨在评价替西帕肽作为IIH辅助治疗的疗效。方法使用TriNetX全球健康研究网络进行回顾性队列分析,分析截至2024年11月的数据。通过倾向评分匹配,我们比较了193例暴露于替西肽的IIH患者和193例接受标准治疗的对照组。主要结局包括在多个随访时间点监测的乳头水肿严重程度、视觉功能、头痛频率和治疗耐药性。结果:我们的分析显示,替西帕肽组所有测量结果均有显著改善。在24个月时,我们观察到乳头水肿风险降低68% (RR 0.320, 95% CI 0.189-0.542, p < 0.001),视觉障碍和失明风险降低73.9% (RR 0.261, 95% CI 0.143-0.477, p < 0.001),头痛风险降低19.7% (RR 0.803, 95% CI 0.668-0.966, p = 0.019)。与对照组相比,替西肽组在24个月时体重指数显著降低,达到- 1.147 kg/m2 (95% CI [- 1.415, - 0.879], p < 0.001)。结论:我们的研究结果表明,替西帕肽作为辅助治疗,在IIH治疗中提供了显著的治疗效果,特别是在改善乳头水肿和视力方面。我们的研究结果表明,双GIP/GLP-1受体激活可能比传统的单受体治疗更具优势,可能通过增强代谢调节和直接影响ICP动力学。