Objective:

To evaluate the efficacy of GLP-1 receptor agonists (GLP-1 RAs) on weight management, headache frequency, and visual outcomes in patients with idiopathic intracranial hypertension (IIH).

Background:

IIH, predominantly affecting young obese women, is presented clinically in chronic headaches, papilledema, and risk of visual loss. Giving the emerging evidence of GLP-1RAs in managing weight and the strong association between IIH and obesity, their therapeutic potential in IIH require systemic evaluation.

Design/Methods:

This systematic review adhered to PRISMA guidelines and is prospectively registered to PROSPERO. We searched PubMed, Scopus, Embase, and Web of Science through June 2025 using terms related to IIH and GLP-1 RAs. Observational and randomized controlled studies evaluating GLP-1 RAs in adults with diagnosed IIH were included. Primary outcomes were BMI change, headache frequency, and visual parameters. Meta-analysis was performed using STATA with mean differences and 95% confidence intervals.

Results:

We included a total of seven studies with 12,200 patients for analysis. In comparison with the control group, BMI and monthly headache days were significantly reduced by GLP 1RAs (MD: –0.98 kg/m2; 95% CI: [–1.38 to –0.57], p-value < 0.001), (MD: –3.45 days; 95% CI:[–5.57 to –1.50], p-value < 0.001) respectively. Visual acuity at 6 months showed a significant improvement (MD: 0.10; 95% CI: [0.02 to 0.18], p-value = 0.02), while visual field reduction was significantly less in the GLP-1 RA group (MD: -1.95; 95% CI: -3.32 to -0.58, p=0.01). We observed no significant differences in peripapillary retinal nerve fiber layer thickness or Frisén scale changes.

Conclusions:

GLP-1RAs showed promising effects in patients with IIH through weight and headache frequency reduction. The long-term visual effects were promising through higher visual acuity and a good visual field. Large-scale studies are needed for a better understanding of the effects of GLP-1RAs in IIH.