ESSIC uses the name bladder pain syndrome (BPS) instead of interstitial cystitis (IC) and/or painful bladder syndrome (PBS): click here for more details.
A
prospective, randomized, placebo controlled, double-blind study
of amitriptyline for the treatment of interstitial cystitis. van Ophoven A, Pokupic S, Heinecke A, et
al. J Urol 2004;172:533-6 • the authors conclude that amitriptyline therapy for 4 months is safe and effective for treating IC
• a statistically significant change in the symptom score and statistically significant improvement of pain and urgency intensity compared with placebo were observed
• anticholinergic side effects constitute the major drawback of amitriptyline treatment for IC
see also: Efficacy of tricyclic antidepressant is associated with beta2-adrenoceptor genotype in patients with interstitial cystitis. Nishijima S, Sugaya K, Yamada T, et al. Biomed Res 2006;27:163-7 • the efficay of imipramine was studied in 55 IC patients and 113 controls in relation to the polymorphism of the beta2-adrenoreceptor (ADRB2)
• the results suggest that the Arg16Gly polymorphism of ADRB2 is related to down-regulation of ADRB2 expression in the detrusor muscle and that the response of IC to tricyclic antidepressant therapy depends on the Arg16Gly polymorphism.
Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Nickel JC, Barkin J, Forrest J, et al. Urology 2005;65:654-8 • three dosages (300, 600, and 900 mg) of PPS in a randomized, double-blind, double-dummy, parallel-group, multicenter, 32-week study were studied in 380 IC patients
• at study end, 27.5%, 56.9%, and 15.7% reported mild, moderate, and severe symptoms, respectively • for all three dosages of PPS, a clinically significant but similar response was demonstrated; the duration of therapy appears to be more important than the dosage
Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis. Warren JW, Horne LM, Hebel JR, et al. J Urol 2000;163:1685-8
• 50 patients with IC were randomized to receive 18 weeks of placebo or antibiotics, including rifampin plus a sequence of doxycycline, erythromycin, metronidazole, clindamycin, amoxicillin and ciprofloxacin for 3 weeks each.
• 12 of 25 patients (48%) in the antibiotic and 6 of 25 (24%) in the placebo group reported overall improvement (p = 0.14), while 10 and 5, respectively, noticed improvement in pain and urgency (p = 0.22).
• in the antibiotic group 20 participants (80%) had adverse effects compared with 10 (40%) in the placebo group (p = 0.009).
• the authors conclude that their findings suggest that these antibiotics alone or in combination may sometimes be associated with decreased symptoms in some patients but they do not represent a major advance in therapy for interstitial cystitis
A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. Cartledge JJ, Davies AM, Eardley I. BJU Int 2000;85:421-6
• the authors conclude that oral L-arginine produces a statistically significant improvement in the IC symptom index in patients with IC, but the effect is small; this effect may not be clinically significant as there were no improvements in the other variables assessed and no significant difference between the response to L-arginine and placebo
• from these results the use of L-arginine cannot be recommended for treating IC
A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease. Holm-Bentzen M, Jacobsen F, Nerstrom B, et al. J Urol 1987;138:503-7 • protocol A included 43 patients with clinically and pathologically anatomically verified interstitial cystitis (28 or more mast cells per mm.2)
• protocol B included 72 patients with a painful bladder and unspecific histological findings
• patients were randomized to receive either sodium pentosanpolysulfate (200 mg. twice daily) or placebo capsules for 4 months
• before and after the trial the patients were evaluated with symptom grading, urodynamics and cystoscopy with distension and deep bladder biopsies
• the results showed no difference between the pre-trial and post-trial values in the sodium pentosanpolysulfate and placebo groups in both protocols in regard to symptoms, urodynamic parameters, cystoscopic appearance and mast cell counts.
• a significant increase in the cystoscopically determined bladder capacity in the sodium pentosanpolysulfate group in protocol A was found
• the authors conclude that no statistically or clinically significant effect of sodium pentosanpolysulfate was found compared to placebo in patients with painful bladder disease
Time to Initiation of Pentosan Polysulfate Sodium Treatment After Interstitial Cystitis Diagnosis: Effect on Symptom Improvement. Nickel JC, Kaufman DM, Zhang HF, et al. Urology 2008;71:57-61
• this is a retrospective analysis in patients in patients who had been treated with PPS 300 mg/day for 32 weeks in a multi-center, randomized, double-blind, parallel-group clinical trial
• initiation of PPS treatment within 6 months of establishing the diagnosis of IC may be associated with greater improvement in patient symptoms and symptom bother than treatment initiation 24 months or more after IC diagnosis
The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observatinal study. van Ophoven A, Hertle L.J Urol 2007;177:552-5
• in this observational study, duloxetine was given for two months to 48 women with IC according to the NIDDK criteria
• 5 patients (10.4%) responded and 17 (35.4%) dropped out due to nausea as a side effect
• patients who responded reported onset of improvement but not until they had reached the target dose of 2x 40 mg per day
• the authors conclude that
duloxetine did not result in significant improvement of symptoms in patients with IC
Long-term results of amitriptyline treatment for interstitial cystitis.van Ophoven A, Hertle L. J Urol 2005;174:1837-40 • the authors conclude that long-term
administration of amitriptyline is a safe and effective treatment
for IC, provided that the drug is used judiciously to minimize
adverse effects
Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Nickel JC, Barkin J, Forrest J, et al. (Elmiron Study Group). Urology 2005;65:654-8 • for all three dosages of oral PPS (300,
600, and 900 mg), a clinically significant but similar response
was demonstrated
• the duration of therapy appears to be more important than the dosage
• a limitation of this study is the lack of a placebo group
The cysteinyl leukotriene D4 receptor antagonist montelukast for the treatment of interstitial cystitis. Bouchelouche K, Nordling J, Hald T, Bouchelouche P. J Urol 2001;166:1734-7 • montelukast treatment resulted in significant improvement in urinary frequency and pain
• its efficacy for decreasing urinary frequency and pain imply a role of leukotriene receptor antagonists for managing interstitial cystitis but further placebo controlled clinical studies are needed
A novel highly effective treatment of interstitial cystitis causing chronic pelvic pain of bladder origin: case reports. Check JH, Katsoff B, Citerone T, Bonnes E. Clin Exp Obstet Gynecol 2005;32:247-9
• two women with interstitial cystitis that had been refractory to various therapies were treated with dextroamphetamine sulfate
• both patients quickly improved their bladder symptoms, all pain and urgency was gone within a week and the IC remission as long as the women stayed on their medication
Efficacy of interstitial cystitis treatments: a review. Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J. EAU-EBU Update Series 2006;4:47-61
• in this article, the degree of evidence regarding the clinical efficacy of available interstitial cystitis treatment options is reviewed
• only three therapies are supported by a high level of evidence: oral cimetidine and amitriptyline and the intravesical dimethylsulfoxide (DMSO)
Chondroitin sulfate for interstitial cystitis. Palylyk-Colwell E. Issues Emerg Health Technol 2006 May;(84):1-4
• this review concludes that two non-randomized, uncontrolled pilot studies reported improvements in patient-reported symptoms after the use of chondroitin sulfate for one year
• the author also concludes that prospective, randomized, head-to-head trials are needed to assess the effectiveness of this technology compared with other IC therapies
Antidepressants and cognitive-behavioral therapy for symptom syndromes. Jackson JL, O'malley PG, Kroenke K. CNS Spectr 2006;11:212-22
• this article reviews the randomized controlled trial data for the use of antidepressant and cognitive-behavior therapy for 11 somatic syndromes: irritable bowel syndrome, chronic back pain, headache, fibromyalgia, chronic fatigue syndrome, tinnitus, menopausal symptoms, chronic facial pain, noncardiac chest pain, interstitial cystitis, and chronic pelvic pain
Patient perceived outcomes of treatments used for interstitial cystitis. Hill JR, Isom-Batz G, Panagopoulos G, et al. Urology 2008;71:62-6 • 750 patients with a diagnosis of IC completed a computerized survey that queried each patient about their demographics, symptoms, concomitant diagnoses, treatments, and their perceived treatment outcomes
• the authors conclude that medical therapy is perceived to be superior to invasive therapy in the treatment and that several medications showed a large percentage of patients with improvement in symptoms
• these medications were calcium glycerophosphate, phenazopyridine and pentosan polysulfate sodium comment: this study may be biased as the survey was a direct link from 3 websites, at least one of them being a commercial site
