Pentosan Polysulfate Maculopathy: What Urologists Should Know in 2020

Mogica, Jan Alberto Paredes; De, Elise

doi:10.1016/j.urology.2020.08.072

Cited by 18 publications

(14 citation statements)

References 22 publications

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“…However, a Cochrane review performed in 2020 found no evidence that PPS use led to improvement of pain, frequency, or nocturia or increased likelihood of cure when compared to controls 11 . Recent studies (2018–2021) have identified a dose‐dependent risk of maculopathy with prolonged PPS exposure that may persist after discontinuation 12 . The association of PPS with maculopathy was not identified until 2018, and so it is not reflected in this study.…”

Section: Discussionmentioning

confidence: 69%

“…11 Recent studies (2018-2021) have identified a dose-dependent risk of maculopathy with prolonged PPS exposure that may persist after discontinuation. 12 The association of PPS with maculopathy was not identified until 2018, and so it is not reflected in this study. We were unable to find any studies that examine how prescription patterns for PPS have changed since 2018, but this will certainly be a future area of interest.…”

Section: Discussionmentioning

confidence: 91%

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Do medication prescription patterns follow guidelines in a cohort of women with interstitial cystitis/bladder pain syndrome?

Tholemeier

Bresee

Hoedt

et al. 2022

Neurourology and Urodynamics

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To describe prescription prevalence of oral bladder pain medications among women with interstitial cystitis/bladder pain syndrome (IC/BPS) and to compare with current treatment guidelines. Methods: We sampled female patients with an ICD-9/10 diagnosis of IC/BPS (595.1/N30.10) by querying active users of the Veterans Health Administration. Medical records were reviewed to determine whether patients met IC/BPS diagnostic criteria. A cohort of women with other pelvic pain disorders was identified. Prescription prevalence of typical non-narcotic oral bladder pain medications was compared between the two groups and healthy controls.Prescription prevalence was also compared before and after the diagnosis of IC/BPS was made using Poisson regression.Results: There were 641 women who met criteria for IC/BPS and 197 women with "Other pelvic pain" disorders. Women with IC/BPS were prescribed a pain medication more often than those with "Other pelvic pain" (77% vs. 59%, p < 0.0001). Of the women with IC/BPS, 44% tried three or more pain medications. Of women with a diagnosis of IC/BPS, only 67% were prescribed an American Urological Association-recommended medication. Prescription prevalence increased after diagnosis for both pentosan polysulfate (10%-29%, p < 0.0001) and hydroxyzine (17%-40%, p < 0.0001), but not for amitriptyline or cimetidine. Amitriptyline was prescribed to 223 women with IC/BPS, only 125 of which (56%) had a documented history of depression.Conclusions: Many women with IC/BPS required multiple bladder prescriptions, highlighting the difficulty in finding an effective treatment for IC/BPS. Pentosan polysulfate and hydroxyzine were preferred IC/BPS medications.Our next step will be to analyze treatment patterns in those patients who did not receive medications.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 91%

Do medication prescription patterns follow guidelines in a cohort of women with interstitial cystitis/bladder pain syndrome?

Tholemeier

Bresee

Hoedt

et al. 2022

Neurourology and Urodynamics

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show abstract

“… 5–11 , 13 Ludwig et al did not find a statistically significant correlation between PPS usage and pigmentary retinopathy in an insurance database review, 17 but the majority of the patients were on PPS for less than 1 year, only 29% had eye exams, and only 0.26% had more than 5 years of use. 18 In a cohort study by Hanif et al, patients with IC exposed to PPS had a 25% prevalence of maculopathy, compared to 2.8% in the IC group without PPS. 9 Jain et al found an association between maculopathy and over 7 years of PPS use in a review of insurance data.…”

Section: Discussionmentioning

confidence: 98%

Pentosan Polysulfate Sodium-Associated Pigmentary Retinopathy: Risk Factors and Fundus Findings

Leung¹,

Sharma²,

Levie-Sprick³

et al. 2021

OPTH

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Purpose To evaluate the risk factors and fundus findings of patients with potential PPS-associated retinopathy. Patients and Methods A retrospective chart review was performed of patients exposed to PPS who had a dilated fundus examination at a large retina-only practice from 2018–21. Multimodal images were evaluated by masked reviewers. Results A total of 148 patients were included, of whom 33 (22%) had PPS-associated retinopathy, and 115 (78%) did not. The mean age was 60.3 years old, and the mean follow-up was 11.8 months. The PPS-associated retinopathy group had higher mean cumulative doses of PPS (1600g±849 vs 864g±852, P < 0.0001, Mann–Whitney test) and longer duration of PPS use (13.6 years vs 7.48, P < 0.0001). There was no statistically significant difference based on a history of kidney or liver disease or the dosage per day for the weight, body mass index, body surface area, or lean body weight. Of the patients with PPS-associated retinopathy whose genetic results were available, 15 of 16 (93%) were heterozygous for variants of uncertain significance. Conclusion A longer duration of PPS use and higher cumulative dosage of PPS were associated with an increased risk of developing PPS-associated pigmentary retinopathy. The role of genetic mutations in patients exposed to PPS is still to be determined.

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“…Pentosan polysulfate sodium (PPS) (Elmiron, Jannsen Pharmaceuticals, Inc., Beerse, Belgium) was initially approved by the FDA in 1998 and is the only oral FDA-approved medication specifically for the symptomatic treatment of interstitial cystitis [ 16 ]. PPS has recently been associated with a toxic maculopathy, as shown in Fig.…”

Section: Pentosan Polysulfate Sodiummentioning

confidence: 99%

“…Another recent retrospective case study of 11 patients who were diagnosed with PPS maculopathy reported that despite cessation of PPS, progression of RPE atrophy continued and patients endorsed worsening visual symptoms [ 26 ]. Given the possible association of PPS with toxic maculopathy, Mogica and De recommended weighing the risks and benefits of use of PPS, as well as performing regular screening ophthalmic exams [ 16 ].…”

Section: Pentosan Polysulfate Sodiummentioning

confidence: 99%

Update on Retinal Drug Toxicities

Hsu

Ponugoti

Deaner

et al. 2021

Curr Ophthalmol Rep

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Purpose of Review This review aims to provide an update on the clinical presentations and diagnostic findings of drug-induced retinal toxicities. Recent Findings Several newly FDA-approved medications have been associated with acute retinal toxicities, including brolucizumab, MEK inhibitors, ulixertinib, and FGFR inhibitors. Additionally, as previously believed-to-be well-tolerated medications, such as pentosan sulfate sodium, anti-retroviral therapies, and certain intraoperative ocular medications, are used more frequently or for longer periods of time, associated toxic retinopathies and inflammatory reactions have been reported. Finally, advances in ocular imaging have revealed novel findings in hydroxychloroquine and tamoxifen maculopathies. Summary Discovery of new medications, increased frequency of use, and longer-term use have led to increased reports of retinal toxicities. Advances in retinal imaging have allowed for earlier detection of subclinical changes associated with these medications, which may help prevent progression of disease. However, more research is needed to determine the point at which vision loss becomes irreversible. Risks and benefits must be assessed prior to discontinuation of the offending, but potentially lifesaving, therapy.

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Pentosan Polysulfate Maculopathy: What Urologists Should Know in 2020

Cited by 18 publications

References 22 publications

Do medication prescription patterns follow guidelines in a cohort of women with interstitial cystitis/bladder pain syndrome?

Do medication prescription patterns follow guidelines in a cohort of women with interstitial cystitis/bladder pain syndrome?

Pentosan Polysulfate Sodium-Associated Pigmentary Retinopathy: Risk Factors and Fundus Findings

Update on Retinal Drug Toxicities

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