Visual and Neurological Outcomes Following Glucagon-Like Peptide-1 Receptor Agonist Therapy and Bariatric Surgery in Idiopathic Intracranial Hypertension: A Network Meta-Analysis

BACKGROUND: Idiopathic intracranial hypertension (IIH) is commonly linked to obesity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and bariatric surgery may improve outcomes beyond conventional therapy, but comparative evidence is limited. METHODS: -scores) were performed. RESULTS: ; 95% confidence interval [CI]: -2.13 to -0.97) and lowered risks of papilledema (relative risk [RR]: 0.47; 95% CI: 0.34-0.65), visual disturbance (RR: 0.48; 95% CI: 0.24-0.98), and headache (RR: 0.78; 95% CI: 0.69-0.88). Changes in papilledema severity and RNFL thickness were not different; visual acuity favored GLP-1RAs at the end of follow-up, whereas visual field values were worse at some time points. In indirect comparisons with bariatric surgery, no significant differences were detected across outcomes. CONCLUSIONS: Adjunctive GLP-1RA therapy may be associated with weight loss and improved clinical/ophthalmic outcomes in IIH relative to conventional care, with a signal for worse visual fields at certain time points. Indirect comparisons suggest comparable efficacy to bariatric surgery. High-quality randomized trials are needed to define comparative effectiveness, safety, and optimal use.