Current status of oral pentosan polysulphate in bladder pain syndrome/interstitial cystitis
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REVIEW ARTICLE
Current status of oral pentosan polysulphate in bladder pain syndrome/interstitial cystitis Rajesh Taneja 1 Received: 19 June 2020 / Accepted: 21 August 2020 # The International Urogynecological Association 2020
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. Keywords Pentosan polysulphate, bladder pain syndrome . Interstitial cystitis
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
* Rajesh Taneja [email protected] 1
Indraprastha Apollo Hospitals, Room Number 1019, Sarita Vihar, New Delhi 110070, India
PRISMA RCT
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Randomized controlled trial
Introduction Bladder pain syndrome/interstitial cystitis (BPS/IC) is a heterogeneous clinical entity, which is still in the evolution phase. Joseph Parrish described this painful bladder condition in 1836, which was later termed as interstitial cystitis by Alexander Skene in 1887 [1]. NIDDK in 1987 defined criteria for diagnosing interstitial cystitis and recommended to have a homogeneous entity without much variation [2]. However, application of these criteria resulted in missing many cases of pain that seemed to be related to the bladder [3]. In 2003, this condition was defined by the International Continence Society as “the complaint of
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