From the Guidelines
Treatment for interstitial cystitis should be individualized and categorized into behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery, as recommended by the 2022 updated Guideline 1. The approach to treating interstitial cystitis has evolved, and the most recent guideline suggests a more personalized treatment plan. Key treatment options include:
- Behavioral and non-pharmacologic interventions, such as dietary modifications, stress management, pelvic floor physical therapy, and bladder training techniques
- Oral medications, including pentosan polysulfate sodium, antihistamines like hydroxyzine, and amitriptyline for pain and frequency management
- Bladder instillations, such as DMSO, heparin, or lidocaine cocktails, typically administered weekly for 6-8 weeks
- Procedures, including botulinum toxin injections into the bladder wall, sacral neuromodulation, or rarely, surgical interventions like cystoplasty or urinary diversion It is essential to note that treatment is typically individualized and may require trying multiple approaches, as interstitial cystitis is a chronic condition with symptoms that can wax and wane over time 1. The 2022 updated Guideline no longer divides treatments into first-line through sixth-line tiers, emphasizing the need for a personalized approach based on the unique characteristics of each patient 1. In addition, the guideline provides new statements on cystoscopy for patients with Hunner lesions, shared decision-making, and potential adverse events from pentosan polysulfate, highlighting the importance of careful consideration and monitoring in treatment planning 1.
From the FDA Drug Label
ELMIRON® is used to treat the pain or discomfort of interstitial cystitis (IC). ELMIRON® was evaluated in two clinical trials for the relief of pain in patients with chronic interstitial cystitis (IC). In this study, 28/74 (38%) of patients who received ELMIRON® and 13/74 (18%) of patients who received placebo, showed greater than 50% improvement in bladder pain (p=0. 005).
- Treatment Options:
- Pentosan polysulfate (PO) is a treatment option for interstitial cystitis.
- The recommended dosage is 100 mg three times a day.
- Key Points:
From the Research
Treatment Options for Interstitial Cystitis
The treatment options for interstitial cystitis (IC) are varied and can be tailored to each specific patient, as the symptoms and severity of the disease can differ greatly from person to person 3.
- Education and Lifestyle Modifications: The American Urological Association (AUA) guidelines recommend starting with education and lifestyle modifications, which can help alleviate symptoms 3.
- Oral Treatments: Oral treatments, such as nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate, have shown varying degrees of efficacy in managing IC symptoms 4.
- Intravesical and Surgical Options: Intravesical and surgical options are also available for patients who do not respond to less invasive therapies 4.
- Pharmacologic Management: Pharmacotherapies, including oral and intravesical agents, can be used to treat IC/BPS, with options such as amitriptyline, hydroxyzine, cyclosporine A, and pentosan polysulfate sodium (PPS) 5.
Efficacy of Pentosan Polysulfate
Pentosan polysulfate sodium (PPS) has been shown to be efficacious in the treatment of IC/BPS symptoms, including bladder pain, urinary urgency, and frequency of micturition 6. However, the results of a randomized, double-blind, placebo-controlled study found no statistically significant difference between the PPS group and the placebo group 7.
Considerations for Treatment
It is essential to consider the individual patient's symptoms and severity of the disease when selecting a treatment option. Additionally, the potential risks and benefits of each treatment, including the recent finding of pigmented maculopathy with chronic PPS use, must be discussed with patients 5.