Abstract
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterised by persistent irritating micturition symptoms and pain. The objective was to compare the clinical efficacy of currently available products for intravesical therapy of BPS/IC and to assess their pharmacoeconomic impact. A Pubmed/Medline database search was performed for articles on intravesical therapy for BPS/IC. A total of 345 publications were identified, from which 326 were excluded. Statistical evaluation was performed with effect size (ES) assessment of symptom reduction and response rates. The final set of 19 articles on intravesical BPS/IC therapy included 5 prospective controlled trials (CTs), the remaining were classified as uncontrolled clinical studies. The total number of patients included was 801, 228 of whom had been evaluated in a CT. For CTs, the largest ES for symptom reduction as well as response rate was observed for high molecular weight hyaluronic acid (HMW-HA), with similar findings in two uncontrolled studies with HMW-HA. The number needed to treat to achieve a response to intravesical therapy was 2.67 for intravesical pentosan polysulphate and 1.31 for HMW-HA which were superior to all other instillates. HMW-HA was significantly superior in cost effectiveness and cost efficacy to all other instillation regimes. The present meta-analysis combined medical and pharmacoeconomic aspects and demonstrated an advantage of HMW-HA over other instillation agents; however, direct comparisons between the different products have not been performed to date in properly designed controlled studies.
Highlights
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterised by persistent irritating micturition symptoms and pain [1]
All titles and abstracts were reviewed to identify studies not directly reporting on BPS/IC or intravesical treatment for BPS/IC, reviews, and other type of publications not suitable for this analysis
From the 33 studies selected according to the outlined criteria, 11 (33.33 %) assessed intravesical therapy with high molecular weight hyaluronic acid (HMW-hyaluronic acid (HA)) 0.08 %, 7 studies presented the results of chondroitin sulphate (ChS) 0.2 % therapy (21.21 %), and 3 studies evaluated treatment with ChS 2.0 % (9.09 %)
Summary
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterised by persistent irritating micturition symptoms and pain [1]. Glycosaminoglycans are classified in four structural families [7] (heparin and heparan sulphates; chondroitin and dermatan sulphates; hyaluronan; and keratan sulphate) and have been used during the last few decades as intravesical instillations for GAG substitution therapy with the benefit of delivering high concentrations of the therapeutic agent at the target tissue with a low risk of systemic side effects [8]. The diversity of available therapeutic agents for GAG substitution may make it difficult for physicians to choose the optimal treatment for their patients [9, 10]; the selection of a particular therapeutic regimen should be based on its capacity for symptom improvement, its impact on the patient’s quality of life, and its costs [10]. Pentosan polysulphate (PPS), a semisynthetic heparin-like GAG of low molecular weight (MW) classically used for oral therapy of BPS/IC, is available for intravesical instillation. Hyaluronan, the salt of hyaluronic acid (HA), and chondroitin sulphate (ChS) are the two most commonly used GAGs for intravesical treatment, alone or in combination
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