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Current status of oral pentosan polysulphate in bladder pain syndrome/interstitial cystitis

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Abstract

Introduction and hypothesis

Oral pentosan polysulphate (PPS) has been used in the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) for almost 35 years. However, in some recent studies, questions have been raised about its efficacy in treating this condition. We aimed to evaluate the published medical literature and discuss the clinical utility of oral PPS in the treatment of BPS/IC.

Methods

PUBMED was searched for BPS/IC, treatment and PPS. Of the initial 398 articles screened, 7 randomized controlled trials, 3 systematic reviews and 3 meta-analyses were finally included in this study (Fig. 1). Other relevant literature such as observational studies and various clinical guidelines was also reviewed. The inclusion criteria, intervention methodology and end points of the studies were examined.

Results

Of the seven RCTs, five found a clear beneficial role of oral PPS in IC/BPS. The only study which did not have cystoscopy as a diagnostic and inclusion criterion failed to show any benefit of oral PPS compared to placebo. Two out of three meta-analyses clearly concluded that oral PPS had a positive role to play in the treatment of BPS/IC. Various open-label studies did conclude in favour of oral PPS as a treatment modality for these patients.

Conclusion

Oral PPS remains a useful pharmacological agent for treatment of BPS/IC, even though it may be effective only in a subgroup of patients.

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Abbreviations

BPS:

Bladder pain syndrome

IC:

Interstitial cystitis

PPS:

Pentosan polysulphate

GAG:

Glycosaminoglycan

ICS:

International Continence Society

IUGA:

International Urogynecology Association

ICI:

International Consultation on Incontinence

NIDDK:

National Institute of Diabetes and Digestive and Kidney Diseases

GRA:

Global response assessment

PORIS:

Patient Overall Rating of Improvement of Symptoms

ICSI:

Interstitial Cystitis Symptom Index

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT:

Randomized controlled trial

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Acknowledgements

This is to acknowledge the invaluable help of Dr. Ranadip Choudhury in the PUBMED search, short listing and listing of the relevant publications during the initial part of the data collection.

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  1. Indraprastha Apollo Hospitals, Room Number 1019, Sarita Vihar, New Delhi, 110070, India

    Rajesh Taneja

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  1. Rajesh Taneja
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Correspondence to Rajesh Taneja.

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Taneja, R. Current status of oral pentosan polysulphate in bladder pain syndrome/interstitial cystitis. Int Urogynecol J 32, 1107–1115 (2021). https://doi.org/10.1007/s00192-020-04517-9

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