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Efficacy and safety comparison of pharmacotherapies for interstitial cystitis and bladder pain syndrome: a systematic review and Bayesian network meta-analysis

Abstract

Introduction and hypothesis

The objective was to compare the clinical efficacy and safety of pharmacological interventions for interstitial cystitis and bladder pain syndrome (IC/BPS) with direct and indirect evidence from randomized trials.

Methods

We searched PubMed, the Cochrane library, and EMBASE for randomized controlled trials (RCTs) that assessed the pharmacological therapies for IC/BPS. Primary efficacy outcomes included ICSI (O’Leary Sant Interstitial Cystitis Symptom Index), ICPI (O’Leary Sant Interstitial Cystitis Problem Index), 24-h micturition frequency, visual analog scale (VAS), and Likert score for pain. Safety outcomes are total adverse events (AEs, intravesical instillation, and others), gastrointestinal symptoms, headache, pain, and urinary symptoms. A systematic review and Bayesian network meta-analysis were performed.

Results

A total of 23 RCTs with 1,871 participants were identified. The ICSI was significantly reduced in the amitriptyline group (MD = −4.9, 95% CI: −9.0 to −0.76), the cyclosporine A group (MD = -7.9, 95% CI: −13.0 to −3.0) and the certolizumab pegol group (MD = −3.6, 95% CI:−6.5 to −0.63) compared with placebo group. Moreover, for ICPI, cyclosporine A showed superior benefit compared to placebo (MD = −7.6, 95% CI: −13 to −2.3). VAS score improved significantly in cyclosporine A group than pentosan polysulfate sodium (MD = 3.09, 95% CI: 0.13 to 6.07). None of the agents revealed a significant alleviation of 24-h micturition frequency. In terms of safety outcomes, the incidence rate on urinary symptoms for botulinum toxin A was the only variate higher than chondroitin sulfate (MD = −2.02, 95% CI: −4.99 to 0.66) and placebo (MD = −1.60, 95% CI:−3.83 to 0.17). No significant difference was found among the other treatments.

Conclusions

Cyclosporine A might be superior to other pharmacological treatments in efficacy. Amitriptyline and certolizumab pegol were capable of lowering the ICSI as well.

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Acknowledgements

This study was funded by 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant Nos. ZY2016104) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant Nos. ZYGD18011), and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant Nos. ZYGC18015). Project of Science and Technology Department of Sichuan Province (2018SZ0177, 2018SZ0055).

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Di, Xp., Luo, Dy., Jin, X. et al. Efficacy and safety comparison of pharmacotherapies for interstitial cystitis and bladder pain syndrome: a systematic review and Bayesian network meta-analysis. Int Urogynecol J 32, 1129–1141 (2021). https://doi.org/10.1007/s00192-020-04659-w

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Keywords

  • Interstitial cystitis
  • Bladder pain syndrome
  • Pharmacological therapy
  • Clinical trials
  • Systematic review
  • Network meta-analysis