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Indian Journal of Pharmaceutical Education and ResearchNOW IN
Article

Topiramate Versus Acetazolamide for Idiopathic Intracranial Hypertension. A Real-World Data-Based Multicenter Retrospective Study

Mahmoud Mohamed Morsy1, Ahmed Yasser Azzam1,2, Muhammed Amir Essibayi2, Alsaleem Mohammed Abadi3, Nasser Abdulmohsen Alsabaani4, Safar Abadi Alsaleem3, Waleed Abdulwahab Aldhabaan4, Hana Jihad Abukhadijah5, Mohamed Darwesh Morsy6, Aayushi Aarav Garg7, David Joseph Altschu2★★ Corresponding author

  1. 1Department of Medicine, October 6 University Hospital, October 6 University, Giza, EGYPT.
  2. 2Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  3. 3Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, SAUDI ARABIA.
  4. 4Department of Ophthalmology, College of Medicine, King Khalid University, Abha, SAUDI ARABIA.
  5. 5Department of Public Health and Medical Research, Medical Research Center, Hamad Medical Corporation, Doha, QATAR.
  6. 6Department of Clinical Physiology, College of Medicine, King Khalid University, Abha, SAUDI ARABIA.
  7. 7Department of Neurology, The Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, the University of Iowa, Iowa City, USA.

CORRESPONDENCE

David Joseph Altschu

Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

daltschu@montefiore.org

Received: 07-04-2025; Revised: 13-06-2025; Accepted: 29-08-2025.

Volume 60, Issue 2 · pp. 614–629 · PUBLISHED · DOI: 10.5530/ijper.20261194

View on IJPER original site ↗

ABSTRACT

Introduction: Idiopathic Intracranial Hypertension (IIH) is a condition marked by elevated intracranial pressure without mass lesions or hydrocephalus, primarily affecting young obese women. Acetazolamide has been the standard treatment, but its side effects often limit use. Topiramate, an anticonvulsant, has gained attention for its dual role as a carbonic anhydrase inhibitor and weight loss promoter. This study compares the efficacy and safety of topiramate versus acetazolamide in IIH management. Materials and Methods:This international, multicenter retrospective study analyzed electronic health records of IIH patients from 2009 to 2024 across six countries. Propensity score matching balanced baseline characteristics between groups, with outcomes evaluated over 24 months. Primary endpoints included papilledema resolution, headache control, visual outcomes and the incidence of refractory IIH and surgical interventions. Results: In a cohort of 16,654 propensity-matched patients (8,327 per group), topiramate significantly reduced persistent papilledema at 24 months (16.8% vs. 28.8%; p<0.0001) and improved headache control (61.2% vs. 71.3%; p<0.0001). Fewer patients in the topiramate group developed refractory IIH or required surgical interventions, such as therapeutic spinal punctures and optic nerve sheath fenestration (p<0.0001). Conclusion:Topiramate demonstrated superior efficacy compared to acetazolamide in resolving papilledema, controlling headaches and reducing the need for invasive procedures. It may represent a more effective first-line therapy for IIH. Further randomized trials are needed to validate these findings and optimize treatment protocols.

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    Morsy, M. M., Azzam, A. Y., Essibayi, M. A., Abadi, A. M., Alsabaani, N. A., Alsaleem, S. A., Aldhabaan, W. A., Abukhadijah, H. J., Morsy, M. D., Garg, A. A., & Altschu, D. J. (). Topiramate Versus Acetazolamide for Idiopathic Intracranial Hypertension. A Real-World Data-Based Multicenter Retrospective Study. Indian Journal of Pharmaceutical Education and Research, 60(2), 614–629. https://doi.org/10.5530/ijper.20261194