Glucagon-like peptide-1 receptor agonists in idiopathic intracranial hypertension: A systematic review and meta-analysis.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Headache Pub Date : 2026-10-01 Epub Date: 2026-08-20 DOI:10.1111/head.70131

Luciano Falcão, Leonardo B O Brenner, Pedro Lucas Machado Magalhães, Abhishek Goyal, Mariana Leticia de Bastos Maximiano, Kenzo Ogasawara Donato, Rafael Andrade Sampaio Silva, Joao Victor Pereira Gonzalez, da Silva, Anderson Silva Corin, Katherine Zarroli

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引用次数: 0

Abstract

Objectives/background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for type 2 diabetes and obesity, have emerged as promising candidates for idiopathic intracranial hypertension (IIH) due to their metabolic and neurophysiological effects. This systematic review and meta-analysis aims to summarize, synthesize, and quantitatively pool the available evidence on the use of GLP-1 RAs in patients with IIH, focusing on clinical outcomes.

Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched through December 2025 for randomized trials and cohort studies assessing GLP-1 RAs in patients with IIH. Risk of bias was assessed by Risk of Bias in Nonrandomized Studies of Interventions and Cochrane Risk of Bias 2.0. Primary outcomes included papilledema, headache burden, refractory IIH, and visual disturbances.

Results: Eight studies comprising 13,243 patients met inclusion criteria. GLP-1 RAs significantly reduced papilledema risk at 3 months (risk ratio [RR], 0.430; 95% confidence interval [CI], 0.281-0.659; I-squared statistic [I²] = 62.5%) and maintained the benefit through 24 months (RR, 0.469; 95% CI, 0.382-0.576; I² = 18.0%). Headache frequency was also consistently lower at 3 months (RR, 0.690; 95% CI, 0.557-0.853; I² = 71.0%) and at 24 months (RR, 0.796; 95% CI, 0.691-0.916; I² = 68.9%), with similar improvements in visual disturbances at 3 months (RR, 0.408; 95% CI, 0.304-0.547; I² = 36.0%) and 24 months (RR, 0.433; 95% CI, 0.236-0.796; I² = 79.0%), and refractory IIH at 3 months (RR, 0.696; 95% CI, 0.574-0.843; I² = 60.0%) and 24 months (RR, 0.808; 95% CI, 0.715-0.908; I² = 52.0%) compared to control group.

Conclusion: GLP-1 RAs appear associated with improvements in clinical outcomes in IIH, including reductions in papilledema, headache, and visual symptoms. The current evidence base is dominated by observational studies with moderate to serious risk of confounding, resulting in low-certainty, hypothesis-generating evidence. These findings should be interpreted cautiously and primarily serve to inform the design of future well powered randomized controlled trials.

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特发性颅内高压的胰高血糖素样肽-1受体激动剂：系统回顾和荟萃分析。

目的/背景：胰高血糖素样肽-1受体激动剂（GLP-1 RAs）最初用于治疗2型糖尿病和肥胖，由于其代谢和神经生理作用，已成为特发性颅内高压（IIH）的有希望的候选者。本系统综述和荟萃分析旨在总结、综合和定量汇集有关GLP-1 RAs在IIH患者中使用的现有证据，重点关注临床结果。方法：检索PubMed、Embase、Web of Science和Cochrane Library，检索截至2025年12月评估IIH患者GLP-1 RAs的随机试验和队列研究。偏倚风险评估采用非随机干预研究的偏倚风险和Cochrane偏倚风险2.0。主要结局包括乳头水肿、头痛负担、难治性IIH和视觉障碍。结果：8项研究包括13243例患者符合纳入标准。GLP-1 RAs显著降低了3个月时乳头水肿的风险（风险比[RR]， 0.430； 95%可信区间[CI]， 0.281-0.659； i平方统计量[I2] = 62.5%），并维持了24个月的获益（RR, 0.469; 95% CI, 0.382-0.576; I2 = 18.0%）。头痛频率也是一贯的低3个月(RR, 0.690; 95%置信区间,0.557 - -0.853,I2 = 71.0%),在24个月(RR, 0.796; 95%置信区间,0.691 - -0.916,I2 = 68.9%),具有类似视觉障碍的改善在3个月(RR, 0.408; 95%置信区间,0.304 - -0.547,I2 = 36.0%)和24个月(RR, 0.433; 95%置信区间,0.236 - -0.796,I2 = 79.0%),和耐火颅内高压症3个月(RR, 0.696; 95%置信区间,0.574 - -0.843,I2 = 60.0%)和24个月(RR, 0.808; 95%置信区间,0.715 - -0.908,I2 = 52.0%)与对照组相比。结论：GLP-1 RAs似乎与IIH临床结果的改善有关，包括减少乳头水肿、头痛和视觉症状。目前的证据基础主要是观察性研究，具有中等到严重的混淆风险，导致低确定性、产生假设的证据。这些发现应该谨慎地解释，并主要用于指导未来良好的随机对照试验的设计。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Headache 医学-临床神经学

CiteScore

9.40

自引率

10.00%

发文量

172

审稿时长

3-8 weeks

期刊介绍： Headache publishes original articles on all aspects of head and face pain including communications on clinical and basic research, diagnosis and management, epidemiology, genetics, and pathophysiology of primary and secondary headaches, cranial neuralgias, and pains referred to the head and face. Monthly issues feature case reports, short communications, review articles, letters to the editor, and news items regarding AHS plus medicolegal and socioeconomic aspects of head pain. This is the official journal of the American Headache Society.