Overviewing Promising Large-Scale Data on GLP-1 RAs in Idiopathic Intracranial Hypertension: Dennis Rivet, MD

WATCH TIME: 5 minutes

"We saw consistent benefits in symptom reduction, fewer procedures, and decreased medication use—and remarkably, a drop in all-cause mortality—that held true regardless of patient BMI."

Idiopathic intracranial hypertension (IIH), affecting about 34,000 people per year, is characterized by elevated intracranial pressure without an identifiable cause, such as an intracranial mass lesion, hydrocephalus, venous sinus thrombosis, or hypertensive systemic disease. Although IIH is not fully understood mechanistically, it is strongly linked to obesity, present in about 90% of cases. This connection has heightened the conversations around whether glucagon-like peptide 1 receptor agonists (GLP-1 RAs), currently used for type 2 diabetes and weight loss, may be able to treat stroke-related conditions like IIH.

To test this hypothesis, a group of investigators, led by Dennis Rivet, MD, gathered data from the TriNetX US Collaborative Network between 2005 and 2024 on GLP-1 RA use for IIH. Before propensity score matching, the cohort included 603 GLP-1 RA users and 43,770 nonusers. Within the study, the GLP-1 RA group, not blinded to treatment, included therapies such as lixisenatide, albiglutide, dulaglutide, semaglutide, liraglutide, and exantide.

Recently published in JAMA Neurology, findings from the study showed that GLP-1 RA use was associated with significant reductions in medication use, symptoms/signs, and procedural interventions, supporting its potential as a management strategy. Rivet, the Harold I. Nemuth Chair in Neurological Disorders at Virginia Commonwealth University, sat down with NeurologyLive® to give insights on the data and its significance. In the interview, he spoke about some of the greatest takeaways, including the lower all-cause mortality at 1 year–a finding not seen in patients who underwent bariatric surgery. Furthermore, he spoke on the specific GLP-1 RAs observed in the trial and whether there might be one medication more effective than others.

REFERENCE
1. Sioutas GS, Mualem W, Reavey-Cantwell J, et al. GLP-1 Receptor Agonists in Idiopathic Intracranial Hypertension. JAMA Neurol. Published online July 14, 2025. doi:10.1001/jamaneurol.2025.2020