Kravetz Liron, Leeman Samuel, Regev Tamir, Walter Eyal, Horev Anat, Ofri Mai, Kerman Tomer, Watted Muhamad, Buklan Karina, Hin Wasim, Elobra Yasmin, Tsumi Erez
Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University, Beersheva, Israel.
Medical School for International Health, Ben-Gurion University, Beersheva, Israel.
Eye (Lond). 2025 Apr 29. doi: 10.1038/s41433-025-03807-0.
Idiopathic intracranial hypertension (IIH) is a neurological condition marked by elevated intracranial pressure (ICP) with no evident secondary cause, primarily affecting obese females of childbearing age. While acetazolamide is the standard medical therapy, weight loss is also considered a first-line treatment. Recently, glucagon-like peptide 1 (GLP-1) agonists have garnered interest for IIH management due to their weight reduction and potential CSF production-decreasing effects. This study evaluates the effect of GLP-1 agonists on ocular parameters of IIH.
A retrospective cohort study was conducted using data from 79 IIH patients who met the modified Dandy criteria and were diagnosed between January 2016 and July 2023. All included patients received acetazolamide, while some received additional therapy with a GLP-1 agonist, either liraglutide or semaglutide. The acetazolamide monotherapy group was compared with the combined therapy group. Data on ocular parameters and BMI changes were collected from the Soroka Medical Center's electronic medical records. Patients with incomplete electronic documentation or with any history of invasive interventions were excluded from the study.
When comparing 68 patients on acetazolamide alone to 11 patients on combined therapy with acetazolamide and GLP-1 agonists, no significant differences were found in any of the parameters: papilledema grade, best corrected visual acuity (BCVA), visual field (VF) or OCT RNFL thickness improvements over a 12-month period. Seven of the 11 patients in the combined therapy group completed the full year of follow up data and were included in the secondary outcome analysis, which revealed a trend of BMI reduction and possible acetazolamide dose reduction following GLP-1 initiation.
This study suggests that GLP-1 agonists effectively reduce BMI, a major risk factor for IIH. Moreover, our analysis of seven patients from the combined therapy group suggests that GLP-1 agonists allow for a reduction in acetazolamide dosage in the treatment of IIH without changing the clinical outcome.
特发性颅内高压（IIH）是一种神经系统疾病，其特征为颅内压（ICP）升高且无明显的继发原因，主要影响育龄肥胖女性。虽然乙酰唑胺是标准的药物治疗方法，但减重也被视为一线治疗手段。最近，胰高血糖素样肽1（GLP-1）激动剂因其减重作用以及潜在的降低脑脊液生成的效果，在IIH治疗中引起了关注。本研究评估GLP-1激动剂对IIH眼部参数的影响。
采用回顾性队列研究，使用2016年1月至2023年7月期间符合改良丹迪标准并被诊断为IIH的79例患者的数据。所有纳入患者均接受乙酰唑胺治疗，部分患者额外接受了GLP-1激动剂（利拉鲁肽或司美格鲁肽）治疗。将乙酰唑胺单药治疗组与联合治疗组进行比较。从索罗卡医疗中心的电子病历中收集眼部参数和体重指数（BMI）变化的数据。电子文档不完整或有任何侵入性干预史的患者被排除在研究之外。
将68例仅接受乙酰唑胺治疗的患者与11例接受乙酰唑胺和GLP-1激动剂联合治疗的患者进行比较，在任何参数上均未发现显著差异：视乳头水肿分级、最佳矫正视力（BCVA）、视野（VF）或光学相干断层扫描视网膜神经纤维层（OCT RNFL）厚度在12个月内的改善情况。联合治疗组的11例患者中有7例完成了全年的随访数据，并纳入次要结局分析，结果显示开始使用GLP-1后有BMI降低的趋势以及可能的乙酰唑胺剂量减少。
本研究表明，GLP-1激动剂可有效降低IIH的主要危险因素BMI。此外，我们对联合治疗组7例患者的分析表明，GLP-1激动剂在不改变临床结局的情况下，可减少IIH治疗中乙酰唑胺的剂量。
