An evaluation of the pharmacotherapy for interstitial cystitis

ABSTRACT

Introduction: Interstitial cystitis (IC) and bladder pain syndrome (BPS) are chronic conditions that can be debilitating for patients. There is no consensus as to their etiology, and there are many proposed treatment algorithms. Oftentimes multimodal therapy, such as combining behavioral modification and physical therapy alongside pharmacotherapies, will be utilized. With the various treatment options available to patients and providers, there is an ever-growing need to implement evidence-based therapies.

Areas covered: The authors explore the different pharmacotherapies as commonly recommended in the American Urological Association (AUA) and European Association of Urology (EAU) multitiered guidelines for IC/BPS treatment as well as other investigational therapies. Pharmacotherapies targeting bladder, pelvic, and/or systemic factors in the overall treatment of IC/BPS are discussed with a particular focus on evidence-based guideline therapies. This article also looks at emerging therapies of interest.

Expert opinion: IC/BPS is a syndrome that requires a multimodal approach, including clinical phenotyping and directed therapy based on the patient’s symptoms. The AUA and EAU provide guidelines for practitioners to follow, but adequate treatment requires the therapy to be targeted toward the patient’s phenotypic domain.

KEYWORDS:

• Bladder pain syndrome
• interstitial cystitis
• intravesical therapy

Declaration of Interest

D Shoskes is a consultant for Aquinox Pharmaceuticals and Farr Laboratories. The authors have no other 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 apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Article highlights

• A focused history and physical exam should be performed on every patient with suspected interstitial cystitis/bladder pain syndrome.

• Clinical phenotyping into specific domains based on the UPOINT system allows the therapy to be targeted toward the patient’s primary complaints.

• Of the guideline-based oral therapies, amitriptyline has the strongest evidence supporting its use.

• While commonly prescribed, evidence supporting pelvic pain syndrome in this patient population is lacking.

• Guideline-based intravesical therapies have mixed evidence, especially when instilled as monotherapy rather than in a cocktail with other agents.

• Evidence supporting many of the commonly used oral and intravesical therapies is not strong, and additional randomized, placebo-controlled studies are needed.

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Additional information

Funding

This manuscript was not funded.