Pentosan Polysulfate–Associated Macular Disease in Patients With Interstitial Cystitis

Lyons, Riley J.; Ahmad, Samera; Ansari, Sana; Foote, Jenelle; Jain, Nieraj

doi:10.1097/aog.0000000000003794

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…In this regard, it is recommended to use the drug with caution, and patients who are prescribed doses that exceed 500 g should undergo an eye examination with visualization of the retina. [27][28][29] In addition, it is worth noting that some of the studies included in our review used intravesical administration of PPS. However, this route of drug administration did not show a significant difference or a better effect relative to the oral route.…”

Section: Discussionmentioning

confidence: 99%

Pentosan polysulfate in patients with bladder pain syndrome/interstitial cystitis with Hunner’s lesions or glomerulations: systematic review and meta-analysis

Grigoryan

Kasyan

Pivazyan

et al. 2022

Therapeutic Advances in Urology

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Background: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a persistent pain perceived in the urinary bladder region, accompanied by at least one symptom, such as pain worsening with bladder filling and daytime or nighttime urinary frequency without any proven infection or obvious pathology. The aim of this study is to evaluate the efficacy and safety of pentosan polysulfate (PPS) in patients with BPS/IC. Methods: Systematic search was performed by PRISMA checklist. Electronic databases, including PubMed and Cochrane library, were checked until 2021 using keywords: ‘pentosan polysulfate’, ‘pain syndrome’, ‘interstitial cystitis’, and bibliography of relevant papers was checked. Inclusion criteria: Patients with confirmed diagnosis of BPS/IC and cystoscopy criteria – Hunner’s lesions. Exclusion criteria included hypersensitivity, pregnancy, lactation, and oral therapy for BPS/IC in the period of 1 month before the study and abstracts or unpublished papers. Results: In total, 13 clinical trials were included in systematic review and 7 were included in meta-analysis. Studies evaluated the effectiveness and safety of oral PPS versus placebo or other treatment options. In the first meta-analysis, three studies compared oral PPS with placebo: [relative risk (RR) = 2.07, 95% confidence interval (CI): 1.37–3.13, p = 0.0006]. The second meta-analysis of two studies compared oral PPS with another treatment options (intravesical liposome and CyA): (RR = 0.44, 95% CI: 0.10–1.93, p = 0.28). The third meta-analysis of two studies included intravesical regimen of PPS compared with intravesical placebo: (RR = 1.09, 95% CI: 0.54–2.22, p = 0.80). The majority of studies do not report any particular serious side effects. Conclusion: PPS treatment has a statistically significant effect over placebo on the subjective improvement of patients with BPS/IC. There was no difference between PPS and other treatment options. Intravesical regimen of PPS had no significant impact on response rates. None of included studies reported severe side effects after intervention.

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Section: Discussionmentioning

confidence: 99%

Pentosan polysulfate in patients with bladder pain syndrome/interstitial cystitis with Hunner’s lesions or glomerulations: systematic review and meta-analysis

Grigoryan

Kasyan

Pivazyan

et al. 2022

Therapeutic Advances in Urology

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“…Lyons et al also recommend prescribing the lowest dose and duration of the medication if the decision to start PPS is made. 17 Our study adds to the growing body of work that supports the presence of a distinct pigmentary maculopathy associated with chronic usage of PPS. Future study is warranted, and guidelines are in the process of being established for the screening for PPS-associated maculopathy.…”

Section: Discussionmentioning

confidence: 56%

Maculopathy Secondary to Pentosan Polysulfate Use: A Single-Center Experience

Kalbag¹,

Maganti²,

Lyon³

et al. 2021

OPTH

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Aim: To investigate the prevalence of retinal pathology in patients with a history of exposure to pentosan polysulfate sodium (PPS). Methods: Patients exposed to PPS and seen in the ophthalmology clinic at Northwestern University during 1/1/2002 to 1/1/2019 were identified from electronic health records (EHR) by an electronic data warehouse (EDW) search. Visual acuity (VA), reasons for clinic visit, ocular conditions, and duration of exposure to PPS were noted. Chart review was performed for fundus exam findings and ophthalmologic imaging, specifically fundus photography, fundus autofluorescence, and ocular coherence tomography (OCT) images. When OCT or fundus photography was available, studies were evaluated by two independent graders. Results: A total of 131 patients who were exposed to PPS and seen at the Northwestern Ophthalmology clinic were identified in the EHR. Forty patients of 131 had imaging. Patients with imaging or fundus examination suspicious for PPS maculopathy were placed into the suspect group. Of the 40 patients that had imaging, 5 (12.5%) had features suspicious for PPS maculopathy. Of the remaining 91, 5 (5.4%) had macular pigmentary changes described on fundus exam. Among the 10 patients in the suspect group, the average duration of PPS use was 4.2 years (range 0.3-11.6 years, interquartile range 5.5 years) and the average cumulative dose was 380g (range 29-1092g, interquartile range 132g). Conclusion: A novel drug-induced maculopathy has been associated with PPS use with a distinct clinical constellation that can be accurately identified with multimodal imaging.

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“…●IC/BPS: Most first‐ and second‐line treatments can be conducted via telemedicine including: patient education; self‐care counseling and behavioral modification (including diet changes); stress management techniques; and multimodal pain management using amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate 64 . Caution should be used when prescribing pentosan polysulfate as long‐term use has recently been associated with macular disease 65,66 . Self‐administered bladder instillations could be recommended for flares (EC). ●Dysmenorrhea and premenstrual syndrome: Most conservative treatment guidelines can be conducted via telemedicine, including lifestyle modifications (e.g.…”

Section: Resultsmentioning

confidence: 99%

“… 64 Caution should be used when prescribing pentosan polysulfate as long‐term use has recently been associated with macular disease. 65 , 66 Self‐administered bladder instillations could be recommended for flares (EC). Dysmenorrhea and premenstrual syndrome: Most conservative treatment guidelines can be conducted via telemedicine, including lifestyle modifications (e.g.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Guidance for gynecologists utilizing telemedicine during COVID‐19 pandemic based on expert consensus and rapid literature reviews

Grimes

Balk

Dieter

et al. 2020

Intl J Gynecology & Obste

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Background: COVID-19 has impacted delivery of outpatient gynecology and shifted care toward use of telemedicine. Objective: To rapidly review literature and society guidelines and create expert consensus to provide guidance regarding management of outpatient gynecology scenarios via telemedicine. Search strategy: Searches were conducted in Medline and Cochrane databases from inception through April 15, 2020. Selection criteria: Literature searches were conducted for articles on telemedicine and abnormal uterine bleeding, chronic pelvic pain, endometriosis, vaginitis, and postoperative care. Searches were restricted to available English language publications. Data collection and analysis: Expedited literature review methodology was followed and 10 943 citations were single-screened. Full-text articles and relevant guidelines were reviewed and narrative summaries developed. Main results: Fifty-one studies on the use of telemedicine in gynecology were found. Findings were reported for these studies and combined with society guidelines and expert consensus on four topics (abnormal uterine bleeding, chronic pelvic pain and endometriosis, vaginal discharge, and postoperative care). Conclusions: Guidance for treating gynecological conditions via telemedicine based on expedited literature review, review of society recommendations, and expert consensus is presented. Due to minimal evidence surrounding telemedicine and gynecology, a final consensus document is presented here that can be efficiently used in a clinical setting.

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Pentosan Polysulfate–Associated Macular Disease in Patients With Interstitial Cystitis

Cited by 9 publications

References 9 publications

Pentosan polysulfate in patients with bladder pain syndrome/interstitial cystitis with Hunner’s lesions or glomerulations: systematic review and meta-analysis

Pentosan polysulfate in patients with bladder pain syndrome/interstitial cystitis with Hunner’s lesions or glomerulations: systematic review and meta-analysis

Maculopathy Secondary to Pentosan Polysulfate Use: A Single-Center Experience

Guidance for gynecologists utilizing telemedicine during COVID‐19 pandemic based on expert consensus and rapid literature reviews

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