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

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. 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). 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). 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.