Visual and Neurological Outcomes Following Glucagon-Like Peptide-1 Receptor Agonist Therapy and Bariatric Surgery in Idiopathic Intracranial Hypertension: A Network Meta-Analysis.
Somkiat Phutinart, Noppachai Siranart, Patavee Pajareya et al.
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In 30 seconds
This network meta-analysis compared glucagon-like peptide-1 receptor agonists (GLP-1RAs) and bariatric surgery, each added to conventional care, with conventional management for idiopathic intracranial hypertension. It included eight randomized or observational studies identified through searches to June 2025. Compared with conventional therapy, GLP-1RAs were associated with lower BMI (mean difference -1.55 kg/m²; 95% CI: -2.13 to -0.97) and lower risks of papilledema, visual disturbance, and headache. Visual acuity favored GLP-1RAs at follow-up, but visual field values were worse at some time points. Indirect comparisons found no significant differences from bariatric surgery.
Key findings
- GLP-1RAs reduced BMI versus conventional therapy (mean difference -1.55 kg/m²; 95% CI: -2.13 to -0.97).
- GLP-1RAs were associated with lower risks of papilledema (RR: 0.47; 95% CI: 0.34-0.65), visual disturbance (RR: 0.48; 95% CI: 0.24-0.98), and headache (RR: 0.78; 95% CI: 0.69-0.88).
- Visual acuity favored GLP-1RAs at follow-up, while visual field values were worse at some time points; papilledema severity and RNFL thickness did not differ.
- Indirect comparisons detected no significant differences between GLP-1RAs and bariatric surgery across outcomes.
Why it matters
IIH is commonly linked to obesity, and this synthesis suggests GLP-1RA therapy may be associated with improvements in weight and several clinical or ophthalmic outcomes when added to conventional care. The mixed visual findings, including worse visual field values at some time points, underscore the importance of assessing outcomes separately rather than assuming uniform visual benefit.
What to keep in mind
Only eight studies were included, and the evidence combined randomized and observational designs. Comparisons with bariatric surgery were indirect; the authors call for high-quality randomized trials to establish comparative effectiveness, safety, and optimal use.