Reduction of Cerebrospinal Fluid Leaks in Idiopathic Intracranial Hypertension with Glucagon-like Peptide-1 Receptor Agonist Use

Objectives: Elevated intracranial pressure (ICP) secondary to idiopathic intracranial hypertension (IIH) is a recognized risk factor for anterior and lateral skull base cerebrospinal fluid (CSF) leaks. A recent randomized controlled trial (Mithcell et al. 2023) demonstrated a significant reduction of ICP in IIH with the use glucagon-like peptide-1 (GLP-1) receptor agonists. This retrospective population study aims to evaluate the role of GLP-1 agonists in reducing CSF leaks. Design: Retrospective cohort database study Setting: A collaborative global database (TriNetX) sourced from electronic medical records from 91 large healthcare organizations across the world. Participants: Adults (≥18 years old) with a diagnosis of IIH, stratified into groups based on the presence or absence of concurrent use GLP-1 agonist use. Main Outcome Measures: The rate of spontaneous cranial CSF leak and the rate of anterior/lateral skull base CSF leak repair between GLP-1 users vs. non-users over 3 years. Results: Compared to IIH patients not taking GLP-1 agonists (n=6,987), IIH patients on GLP-1 agonists (n=6,987) were 33% less likely to develop a spontaneous cranial CSF leak (OR 0.67, 95% CI [0.50- 0.89]) and 52% less likely to undergo skull base CSF leak repair (OR 0.44, 95% CI [0.25- 0.93]. Conclusions: GLP-1 agonist use in IIH patients is associated with a lower incidence of spontaneous cranial CSF leaks and a decreased rate of undergoing anterior and/or lateral skull base CSF leak repairs. These promising findings suggest that GLP-1 agonists may be an effective adjuvant therapeutic agent in preventing recurrence following CSF leak repair in IIH patients.