A randomized sequential cross‐over trial evaluating five purportedly ICP‐lowering drugs in idiopathic intracranial hypertension

• DOI: 10.1111/head.14897
• Publication Date: 2025-01-24T11:51:26Z
• Authors: James L. Mitchell; Hannah S. Lyons; Jessica K. Walker; Andreas Yiangou; Mark Thaller; Olivia Grech; Zerin Alimajstorovic; Georgios Tsermoulas; Kristian Brock; Susan P. Mollan; Alexandra J. Sinc...
• Keywords: Acetazolamide; Crossover study

Abstract Objective To gain initial insight into the efficacy to lower intracranial pressure (ICP), side effects, and effects on cognition of five drugs commonly used treat idiopathic hypertension (IIH). Background Limited clinical data exist for treatment IIH. Impaired is recognized in IIH can be exacerbated by medications. Methods This human experimental medicine study was a secondary analysis that focused an unblinded randomized, sequential, cross‐over extension previously completed randomized controlled trial. evaluated females with active IIH, recruited from University Hospital Birmingham, UK. Participants were treated, order, 2 weeks acetazolamide, amiloride, furosemide, spironolactone, topiramate; assessment at baseline minimum 1‐week drug washout between drugs. The primary outcome change ICP post‐drug administration. cognitive evaluation exploratory recorded telemetric, intraparenchymal monitors (Raumedic, Hembrechts, Germany). Adverse events recorded, assessed utilizing National Institutes Health Toolbox Cognitive Battery. Results Fourteen participants intention‐to‐treat analysis. Mean (standard deviation) body mass index 37.3 (7.0) kg/m 33.2 (7.1) cm cerebrospinal fluid (CSF) baseline. fell four (mean [standard error (SE)]), acetazolamide −3.3 (1.0) mmHg, p = 0.001, furosemide −3.0 (0.9) spironolactone −2.7 0.003, topiramate −2.3 0.010. There no significant difference Side common (100%, 11/11) (93%, 13/14). Baseline performance impaired, T ‐score [SE]) 37.2 (2.6). After treatment, there further reduction domain (ability process integrate) [SE]), −5.0 (2.6), 0.057 −4.1 (2.0), 0.061. Conclusions Acetazolamide, marginally reduced ICP. While their not significant, this powered detect reported including decline. measures impaired topiramate. Therapeutics greater favorable effect profile are unmet need