2025 Proffered Presentations
S075: EVALUATING THE ROLE OF ANTI-OBESITY MEDICATIONS IN MODIFYING RISKS OF VISUAL AND CSF COMPLICATIONS IN IDIOPATHIC INTRACRANIAL HYPERTENSION
Arman Saeedi, MPH; Amala Nayak; Michael McWilliams; Theodore A Schuman, MD; Virginia Commonwealth University
Introduction: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a clear cause and is associated with increased risk of headaches, visual disturbances, spontaneous cerebrospinal fluid leak (CSF), encephalocele and papilledema. While obesity and metabolic dysfunction are key risk factors, the pathophysiology of IIH remains poorly understood. Anti-obesity medications, including glucagon-like peptide-1 receptor agonists (GLP-1) and GLP-1/gastric inhibitory polypeptide (GIP) combinations like tirzepatide, are being investigated for their potential in IIH management. These agents may exert beneficial effects by modulating cerebrospinal fluid dynamics, reducing neuroinflammation, and promoting weight reduction. This study evaluates their efficacy and safety in modifying disease progression and improving outcomes for IIH patients.
Methods: A comparative outcomes analysis was conducted using the TriNetX platform, which leverages electronic medical records from 94 healthcare organizations. Two cohorts were defined: Cohort 1 (n = 2,617,891) included patients not on anti-obesity medications post-June 2021, and Cohort 2 (n = 280,775) comprised patients with overweight or obesity on anti-obesity medications (GLP-1 or GLP-1/GIP combinations) from June 1, 2021, onward. Propensity score matching was applied to balance the cohorts for demographic and clinical characteristics, resulting in matched groups of 280,669 patients each. Key outcomes analyzed included the incidence of IIH, CSF leaks, CSF leak repair, papilledema, vision changes, and blindness. Risk is reported as risk ratios.
Results: The matched cohorts were comparable in age (mean age 51.4 vs. 51.3 years), gender distribution (64.1% female in Cohort 1 vs. 64.0% in Cohort 2), and type 2 diabetes prevalence (44.1% in Cohort 1 vs. 44.0% in Cohort 2). The risk of developing IIH was slightly higher in Cohort 1 (0.15%) compared to Cohort 2 (0.13%), but the risk ratio (1.10, 95% CI: 0.95 to 1.26) was not significant (p = 0.198). Papilledema risk was similar (0.1% in both cohorts; p = 0.890). However, significant differences were found for other outcomes: the risk of CSF leaks was higher in Cohort 1 (0.08%) compared to Cohort 2 (0.05%), with a risk ratio of 1.73 (95% CI: 1.39 to 2.16, p < 0.001). Vision changes and blindness were also more frequent in Cohort 1, with risk ratios of 1.25 (95% CI: 1.19 to 1.32, p < 0.001) and 1.43 (95% CI: 1.33 to 1.54, p < 0.001), respectively. Notably, the need for surgical repair was significantly higher in Cohort 1 (0.03%) compared to Cohort 2 (0.01%), with a risk ratio of 3.88 (95% CI: 2.47 to 6.07).
Conclusion: The analysis suggests that anti-obesity medications may have a protective effect on certain outcomes associated with IIH, such as CSF leaks, vision changes, and blindness, although the direct impact on IIH risk was not significant. These findings support the potential role of anti-obesity medications in reducing complications related to IIH and underscore the need for further clinical studies to explore their efficacy and safety in this context. The propensity-matched analysis provides a strong basis for future research on therapeutic strategies for IIH, particularly in populations at high risk due to obesity and metabolic dysfunction.