Effect of Semaglutide on Recurrence of Intracranial Hypertension After Venous Sinus Stenting: A Two-Phase Cohort Study
Semaglutide may reduce the recurrence of intracranial hypertension after venous sinus stenting, but further research is needed to confirm these findings.
Where it sits
this study against the rest of the semaglutide corpusSummary and findings
This study measured the effect of semaglutide on the recurrence of intracranial hypertension (IH) after venous sinus stenting in patients with idiopathic intracranial hypertension (IIH). A total of 34 patients were assigned to receive either semaglutide or standard care. The findings suggested that semaglutide may reduce recurrence rates and improve other metrics compared to controls.
Abstract
Abstract Background Venous sinus stenting (VSS) effectively resolves mechanical outflow obstruction in idiopathic intracranial hypertension (IIH), yet recurrence remains a non-negligible risk. Metabolic drivers, particularly obesity, may undermine long-term success. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide offer potent weight loss and potential cerebrospinal fluid modulation, but their role in post-stenting management is unestablished. We investigated whether baseline body mass index (BMI) predicts IH recurrence following VSS and whether adjunctive semaglutide reduces recurrence risk in a non-randomized exploratory cohort. Methods We conducted a two-phase cohort study. Phase 1 retrospectively analyzed 50 IIH patients with transverse sinus stenosis (TSS) undergoing VSS (2018–2023) to identify recurrence predictors. Phase 2 prospectively assigned 34 IIH patients (2024–2025) to semaglutide (n = 17) or standard care (n = 17). The primary outcome was intracranial hypertension (IH) recurrence (lumbar puncture opening pressure ≥ 250 mmH₂O) at 16 weeks. Secondary outcomes included pressure metrics, weight change, symptom scores, and optic measures. Results In Phase 1, higher baseline body mass index (BMI) (OR 1.206, 95% CI 1.008–1.444, P = 0.041) independently predicted intracranial hypertension (IH) recurrence after VSS. In Phase 2, semaglutide significantly reduced IH recurrence compared to controls (5.9% vs 35.3%, P = 0.034). Semaglutide also lowered follow-up opening pressure (205.29 vs 249.71 mmH₂O, P = 0.007), reduced BMI (median ΔBMI − 4.00 vs 0.00 kg/m², P < 0.001), a lower rate of persistent papilledema (17.6% vs 52.9%; P = 0.031), and alleviated tinnitus (median ΔTFI − 15.40 vs 0.00, P = 0.040). Adverse events were mild-to-moderate gastrointestinal symptoms. Conclusion In this cohort, higher baseline BMI was identified as a risk factor for IH recurrence after VSS in IIH. Adjunctive semaglutide therapy was associated with a lower recurrence rate ang greater weight loss, supporting its integration into post-stenting metabolic management. Given the exploratory design and small sample size, all findings are hypothesis-generating and require confirmation in larger randomized trials. Trial registration: NCT06361823. Registered on March 2, 2024, by Xuanwu Hospital, Capital Medical University.