The emerging role of glucagon-like peptide-1 receptor agonists in idiopathic intracranial hypertension: Therapeutic potential and challenges

Weight reduction is a well-established disease-modifying intervention in the management of idiopathic intracranial hypertension (IIH), with clinical guidelines commonly recommending a target of at least 10% total body weight loss to achieve meaningful symptom improvement and reduction in intracranial pressure (ICP). Multiple modalities can be employed to facilitate weight loss, including lifestyle modification, pharmacologic therapy, and bariatric surgery. Among pharmacologic interventions, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have demonstrated superior efficacy in achieving significant weight loss compared to conventional weight management strategies. Recent reports from ongoing studies have also indicated that GLP-1 RAs may reduce the need for acetazolamide, a standard treatment used to decrease cerebrospinal fluid (CSF) production in IIH, as they not only reduce ICP through weight loss but also have direct effects on CSF production. This review evaluates the role of GLP-1 RAs in IIH, highlighting their mechanisms, benefits, and emerging research. Challenges include limited IIH-specific data, high costs, side effects, and the need for long-term therapy. While early findings are promising, larger trials are needed. GLP-1 RAs should complement, not replace, comprehensive lifestyle and multidisciplinary IIH management strategies.