Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria.
J Headache Pain. 2023 Jul 18;24(1):89. doi: 10.1186/s10194-023-01631-z.
In idiopathic intracranial hypertension (IIH), sustained weight loss is the main pillar in modifying disease course, whereby glucagon-like peptide-1 receptor agonists (GLP-1-RAs) could present an attractive treatment option.
In this open-label, single-center, case-control pilot study, patients with IIH (pwIIH) and a body mass index (BMI) of ≥ 30 kg/m were offered to receive a GLP-1-RA (semaglutide, liraglutide) in addition to the usual care weight management (UCWM). Patients electing for UCWM only served as a control group matched for age-, sex- and BMI (1:2 ratio). The primary endpoint was the percentage weight loss at six months (M6) compared to baseline. Secondary endpoints included the rate of patients with a weight loss of ≥ 10%, monthly headache days (MHD), the rate of patients with a ≥ 30% and ≥ 50% reduction in MHD, visual outcome parameters, and adverse events (AEs).
We included 39 pwIIH (mean age 33.6 years [SD 8.0], 92.3% female, median BMI 36.3 kg/m [IQR 31.4-38.3]), with 13 patients being treated with GLP-1-RAs. At M6, mean weight loss was significantly higher in the GLP-1-RA group (-12.0% [3.3] vs. -2.8% [4.7]; p < 0.001). Accordingly, weight loss of ≥ 10% was more common in this group (69.2% vs. 4.0%; p < 0.001). Median reduction in MHD was significantly higher in the GLP-1-RA group (-4 [-10.5, 0.5] vs. 0 [-3, 1]; p = 0.02), and the 50% responder rate was 76.9% vs. 40.0% (p = 0.04). Visual outcome parameters did not change significantly from baseline to M6. Median reduction in acetazolamide dosage was significantly higher in the GLP-1-RA group (-16.5% [-50, 0] vs. 0% [-25, 50]; p = 0.04). AEs were mild or moderate and attributed to gastrointestinal symptoms in 9/13 patients. None of the AEs led to premature treatment discontinuation.
This open-label, single-center pilot study suggests that GLP-1-RAs are an effective and safe treatment option for achieving significant weight loss with a favorable effect on headache, leading to reduced acetazolamide dosage in pwIIH.
在特发性颅内高压（IIH）中，持续减重是改变疾病进程的主要支柱，而胰高血糖素样肽-1 受体激动剂（GLP-1-RAs）可能是一种有吸引力的治疗选择。
在这项开放标签、单中心、病例对照的初步研究中，患有 IIH（pwIIH）且体重指数（BMI）≥30 kg/m²的患者被提供 GLP-1-RA（司美格鲁肽、利拉鲁肽）联合常规体重管理（UCWM）。仅选择 UCWM 的患者作为年龄、性别和 BMI 匹配的对照组（1:2 比例）。主要终点是与基线相比，六个月时（M6）的体重减轻百分比。次要终点包括体重减轻≥10%的患者比例、每月头痛天数（MHD）、MHD 减少≥30%和≥50%的患者比例、视觉结果参数和不良事件（AE）。
我们纳入了 39 名 pwIIH（平均年龄 33.6 岁[标准差 8.0]，92.3%为女性，中位数 BMI 为 36.3 kg/m [IQR 31.4-38.3]），其中 13 名患者接受了 GLP-1-RA 治疗。在 M6 时，GLP-1-RA 组的平均体重减轻明显更高（-12.0%[3.3]与-2.8%[4.7]；p<0.001）。因此，该组体重减轻≥10%的患者更为常见（69.2%与 4.0%；p<0.001）。GLP-1-RA 组 MHD 中位数降低更显著（-4[-10.5，0.5]与 0[-3，1]；p=0.02），50%的应答率为 76.9%与 40.0%（p=0.04）。视觉结果参数从基线到 M6 没有显著变化。GLP-1-RA 组乙酰唑胺剂量中位数降低更显著（-16.5%[-50，0]与 0%[-25，50]；p=0.04）。AE 为轻度或中度，归因于 13 名患者中的胃肠道症状。没有任何 AE 导致提前停药。
这项开放标签、单中心的初步研究表明，GLP-1-RAs 是一种有效且安全的治疗选择，可实现显著的体重减轻，并对头痛有良好的影响，从而降低 pwIIH 的乙酰唑胺剂量。
