Immunotherapy options for painful bladder syndrome: what’s the potential?

ABSTRACT

Introduction: Painful bladder syndrome/interstitial cystitis (PBS/IC) is an enigmatic disease characterized by lack of evidence-based knowledge and an ongoing scientific debate regarding its definition, pathogenesis, diagnostic and treatment algorithm. An autoimmune theory for PBS/IC etiology has suggested immunotherapy as a potential treatment choice.

Areas covered: In this review, the authors report existing and future immunotherapeutic options, potentially valuable to the management of PBS/IC while evidence for the immunological aspect of PBS/IC pathogenesis are also presented. Relevant data reported in human clinical studies but also in experimental studies using animal PBS/IC models have been reviewed.

Expert opinion: Promising data has emerged lately regarding use of immunotherapy drugs for PBS/IC treatment. Specifically, human monoclonal antibodies inhibiting nerve growth factor and tumor necrosis factor-a have shown high efficacy in pain control for PBS/IC. Also, many other agents modulating immunopathways linked to PBS symptom etiology and leading to positive treatment effects have been reported lately mainly in experimental animal studies. Immunotherapy could potentially improve disease-related and patient-reported outcome; nevertheless, lack of consensus regarding PBS/IC diagnostic criteria, leading to high heterogeneity of patients enrolled in PBS/IC treatment studies, and low number of well-designed randomized clinical trials are limitations which must be addressed in the future.

KEYWORDS:

• Painful bladder syndrome
• immunotherapy
• cyclosporine-A
• suplatast tosilate
• adalimumab
• monoclonal antibody

Article highlights

• PBS/IC remains an enigmatic urological syndrome with an ongoing scientific controversy over its definition, pathogenesis, diagnosis and treatment

• The autoimmune theory regarding PBS/IC pathogenesis is gaining support

• Promising results for the use of immunotherapy in the treatment of PBS/IC have been reported mainly in experimental animal studies

• Anti-TNFa human monoclonal antibodies have shown a high efficacy rate regarding the crucial subject of pain management in PBS/IC patients

• Well-designed randomized clinical trials are needed for immunotherapeutic options in order to be included in the treatment algorithm of PBS/IC

This box summarizes key points contained in the article.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript has not been funded.