Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis

The management of interstitial cystitis: an update

“…23 A randomized, controlled trial investigating the use of PPS to treat IC that was published in 2005 is the most vigorous study to date. 24 Various doses have been tested (ranging from 300 mg to 900 mg once a day), but overall response rates approach 15-67% at the 300 mg dose, with no significant improvement seen with higher doses. 24 Ultimately, the duration of dosage appears to be more important than the level of dosage itself.…”

“…24 Various doses have been tested (ranging from 300 mg to 900 mg once a day), but overall response rates approach 15-67% at the 300 mg dose, with no significant improvement seen with higher doses. 24 Ultimately, the duration of dosage appears to be more important than the level of dosage itself. The severity of symptoms does not appear to affect patients' responses to pentosan polysulfate.…”

“…Modest improvements in symptoms have been described at 4 weeks into therapy, with continued steady improvements over time. 24 It is often difficult to delineate symptoms within IC, and determining response to treatment is aimed at evaluating improvement of IC as an entity, rather than just the analgesic effects. On closer inspection of the 2005 study, however, this agent seems to improve urinary frequency symptoms more than pain.…”

What is BPS and how should it be managed in real life clinical practice?

“…The literature surrounding the only oral medication approved for this condition (approved for IC not BPS, a term not recognized by any regulatory organization) clearly shows that the benefits of PPS compared to placebo are at best modest in the short term, 3 however the longer the duration of exposure, the greater the predicted response rate. 4 Some problems and limitations with this study include that it was retrospective, patients who discontinued PPS prior to 3 months were not included, other treatments were not documented and the primary outcome measure was global response assessment which has not be validated for longterm studies and is likely very inaccurate after 3 months. The strengths of this study were that it provides real-life clinical observations on the safety and efficacy of this treatment in Canadian urology outpatients.…”

“…The results corroborated that of a large multicentre, long-term, prospective study that clearly showed that response increased with duration of therapy. 4 However, is PPS an appropriate long-term monotherapy? Despite the suggestion from this study that it is, many patients did not achieve the desired beneficial response and it is very likely that many of those that did had other forms of specific and nonspecific IC directed therapy.…”