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Immunomodulatory Therapies for Interstitial Cystitis/Bladder Pain Syndrome

  • BPS/Interstitial Cystitis (D Castro-Diaz and Y Igawa, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, debilitating condition of unknown etiology characterized by persistent pain perceived to be related to the urinary bladder and lower urinary tract symptoms. Evidence shows that immunological inflammatory responses underlie the pathophysiology of IC/BPS with Hunner lesions but not that of IC/BPS without Hunner lesions. Here, we review the current understanding of the immunological inflammatory nature of IC/BPS with Hunner lesions and the clinical outcomes of immunomodulatory therapies.

Recent Findings

Open trials show that steroids improve validated symptom scores and pain scale score markedly in patients with IC/BPS with Hunner lesions. Open trials and a randomized study show that cyclosporine A improves urinary frequency, pain intensity, and bladder capacity significantly in IC/BPS patients, showing therapeutic superiority in the Hunner lesion subtype. A randomized double-blind study showed that certolizumab pegol significantly improves patient-reported global response assessments of pain, urgency, and overall symptoms, and reduces the Interstitial Cystitis Symptom/Problem Index scores and pain scale score at 18 weeks. These results suggest that immunomodulatory therapy is more effective for IC/BPS patients with Hunner lesions than for IC/BPS without Hunner lesions.

Summary

IC/BPS with Hunner lesions is associated specifically with immunological overreactions in the bladder; thus, immunomodulatory therapy could be a promising treatment option. Further studies focusing on the therapeutic responsiveness of IC/BPS subtypes are warranted to promote a tailored approach to clinical management of IC/BPS. To achieve this therapeutic strategy, clear and proper subtyping of IC/BPS is mandatory.

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Abbreviations

BPS:

Bladder pain syndrome

ESSIC:

International Society for the Study of IC/BPS

GRA:

Global response assessment

IC:

Interstitial cystitis

ICSI:

Interstitial Cystitis Symptom Index

ICPI:

Interstitial Cystitis Problem Index

VAS:

Visual analogue scale

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Authors and Affiliations

  1. Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Yoshiyuki Akiyama

  2. Japanese Red Cross Medical Center, Tokyo, Japan

    Yukio Homma

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  1. Yoshiyuki Akiyama
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Correspondence to Yoshiyuki Akiyama.

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Akiyama, Y., Homma, Y. Immunomodulatory Therapies for Interstitial Cystitis/Bladder Pain Syndrome. Curr Bladder Dysfunct Rep 15, 186–191 (2020). https://doi.org/10.1007/s11884-020-00593-1

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