Association between GLP-1 receptor agonist use and neurosurgical intervention in patients with idiopathic intracranial hypertension and obesity: a propensity-matched, multi-institutional, cohort study.

Introduction: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure and most commonly affects obese women. While its etiology remains unclear, many patients require ventriculoperitoneal shunting (VPS) for symptoms. In those with transverse sinus stenosis, venous sinus stenting (VSS) is an alternative. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been associated with reduced headache burden and visual symptoms in IIH. Since GLP-1 RAs reach steady state around 5 weeks and can produce 10% weight loss by 6 months, we evaluated their impact on neurosurgical/neurovascular procedures at these time points.

Methods: Our retrospective cohort study utilized TriNetX Research Network to compare IIH patients treated with GLP-1 RAs to untreated controls. Propensity score matching balanced demographics, comorbidities, and medication use before comparing odds of neurosurgical interventions, including VSS, VPS, and optic nerve sheath fenestration (ONSF) at ≥5 weeks and ≥6 months after GLP-1 RA initiation. Odds ratios (OR) were estimated via a generalized linear model.

Results: After propensity matching, 2690 patients were included in each group. GLP-1 RA use was linked to lower odds of undergoing VSS at 5 weeks (OR 2.40; CI: 1.44 to 4.00; P=0.0005) and 6 months (OR 2.31; CI: 1.10 to 4.86; P=0.0233) and lower odds of VPS at 5 weeks (OR 3.34; CI: 2.00 to 5.61; P=0.0001) and 6 months (OR 2.51; CI: 1.35 to 4.68; P=0.0026).

Conclusion: GLP-1 RA therapy was associated with lower odds of neurosurgical intervention in IIH patients. These findings support evidence of GLP-1 RAs as a potential noninvasive treatment.