Comparative safety review of current pharmacological treatments for interstitial cystitis/ bladder pain syndrome

ABSTRACT

Introduction: Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a frustrating disease of chronic bladder pain associated with lower urinary tract symptoms. Although there are many proposed treatment algorithms, the uncertainty as to their etiology has a negative impact on the therapeutic outcome. Oftentimes combination therapy of drugs with different mechanisms of action will be utilized to relieve the symptoms. With the various treatment options available to patients and providers, there is an ever-growing need to implement drug efficacy as well as safety to promote best practice in use of the approved drug.

Areas covered: This review will focus on guideline-based pharmacotherapies as described by the AUA and EAU, specifically oral, and intravesical therapies with the most up-to-date published literature. Pharmacotherapies targeting bladder, and/or systemic factors in the overall treatment of IC/BPS are discussed with a particular focus on efficacy and drug safety evaluation.

Expert opinion: IC/BPS is a syndrome that requires bladder targeting agents to restore the urothelium barrier function and inhibit bladder hypersensitivity as well as various drugs with anti-inflammatory effects, and immune modulation effects. Current pharmacotherapies for IC/BPS have various therapeutic effects and adverse effects depending on the dose and individual response.

KEYWORDS:

• Interstitial cystitis
• bladder pain syndrome
• intravesical therapies
• oral medications
• safety

Article highlights

• Lack of consistent biomarkers for diagnosis and follow up of patients is a big challenge in understanding the real role of each drug for the treatment of IC/PBS.

• The current medications for IC/BPS are aimed to diminish the bladder pain and irritative symptoms of bladder, however, durability of therapeutic effects remained to be achieved.

• Of the guideline-based oral therapies, PPS is an oral GAG replenishing therapy with balanced safety profile. While commonly prescribed, evidence supporting efficacy and safety of using amitriptyline, antihistamine, and NSAIDs for daily practice is still demanding.

• Guideline-based intravesical therapy is often used as monotherapy rather than in a cocktail with other oral medication used in real world practice.

• Novel agents with better efficacy and favorable safety profiles are needed to improve the therapeutic outcome for IC/BPS.

• This box summarizes key points contained in the article.

Author contributions

Conceptualization: YCC

Data curation: PYC, WCL

Writing - original draft: PYC, WCL

Writing - review & editing: YCC

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.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.