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GLP-1 RAs and the Role They Play in the Management of IIH

Learn how GLP-1 RAs work in the body and clinical data that may support use by IIH patients.

What are GLP-1 RAs? And what role do they play in the management of idiopathic intracranial hypertension (IIH)?

GLP-1 RA stands for glucagon-like peptide receptor agonists. This class of medication is receiving a lot of attention at the moment because the list of medical conditions it can treat is soaring. 

GLP-1 is a naturally occurring hormone made in the intestine. GLP-1 RAs are the synthetic version of GLP-1. 

The 4 main functions of the GLP-1 hormone is to:

  • Stimulate insulin secretion (regulating blood sugar from the pancreas)
  • Inhibit glucagon secretion (regulating blood sugar from the liver)
  • Decrease intestinal motility (feeling full with less intake)
  • Reduce appetite (tells your brain you are not hungry)

GLP-1 RAs have been on the market since 2005, initially indicated to treat type-2 diabetes mellitus. Because of its success in reversing diabetic complications and achieving weight loss, the indications for use expanded to treat people with a BMI of over 30 or a BMI between 27 and 30 with a high risk condition like a cardiovascular event or high lipids to aid in achieving weight loss. With weight loss, many chronic conditions are reversed or prevented like strokes, heart attacks, and fatty liver disease. 

A portion of patients fit the criteria of having a BMI of over 30 as the primary cause of IIH. In these patients, if one loses more than 10% of their weight, IIH symptoms can improve or resolve. GLP-1 RAs can cross the blood brain barrier so they also can decrease ICP, preventing the cascade of events that occurs in IIH. 

The mechanism of action of GLP-1 including how it decreases ICP.(2)

How do GLP-1 RAs contribute to the treatment of IIH?

In 2021, a study demonstrated that in those patients with obesity and IIH, GLP-1 RA’s helped patients lose weight and also noted that their ICP’s were improved.(1) Another study in 2023 showed that those with IIH and with a BMI greater than 30 were treated with a GLP-1 RA were shown to have a greater than 10% weight loss and they experienced fewer headache days. In a pilot study, 15 patients with IIH had a decrease in their ICP, which in turn allowed them to significantly decrease or discontinue their diamox.(2)

In the management of weight loss, there is no magic pill, or in this case, magic injection. Weight loss requires a multimodal approach which includes: exercise, healthy diet, proper sleep, and decrease of stressors.

The most common side effects are mainly gastrointestinal symptoms. Interestingly there are reports of vision changes with this class of medication such as blurry vision, however reports show it is with older diabetic patients who have diabetic retinopathy.(4) Serious adverse affects such as suicidal thoughts or attempts should be taken seriously and you should seek immediate medical attention. You can call or text 988 or go to the website at https://988lifeline.org/ where you can receive free support 24 hours a day, 7 days a week.

Potential side effects of GLP-1 RAs. (3)

Keep in mind with any new medication on the market there are no long-term studies on its long term effects. For now, GLP-1 RAs are injectables, except for semaglutide (Rybelsus), are intended to be used indefinitely, and may not be covered by your insurance. If you want to know if you are a candidate for a GLP-1 RA, ask your primary care provider or endocrinologist. To learn more about weight loss strategies in IIH, including the use of GLP-1 RAs please attend our next webinar on June 24th at 9:30 am EST.

  1. Mollan SP, Tahrani AA, Sinclair AJ. The Potentially Modifiable Risk Factor in Idiopathic Intracranial Hypertension: Body Weight. Neurol Clin Pract. 2021 Aug;11(4):e504-e507. doi: 10.1212/CPJ.0000000000001063. PMID: 34484948; PMCID: PMC8382420.
  2. Krajnc, N., Itariu, B., Macher, S. et al. Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension. J Headache Pain 24, 89 (2023). https://doi.org/10.1186/s10194-023-01631-z
  3. What to Know When Selecting a Weight Loss Medication. Biocare. Dr. Dawn M. Sweet. Accessed May 20, 2024. https://biocarenutrition.com/pages/glp-1-comparison-chart-semaglutide-versus-tirzepatide?tw_source=google&tw_adid=&tw_campaign=21250940544&gad_source=1&gclid=Cj0KCQjwjLGyBhCYARIsAPqTz186iZN7a2LFZIBTT_XkBL_GQtbR9ZwMM-1_MVUeFZBhLwH2NJOULI4aAoPNEALw_wcB

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