Treatment effect of cyclosporine A in patients with painful bladder syndrome/interstitial cystitis: A systematic review

Abstract

Cyclosporine A (CyA) is emerging as a potential therapeutic strategy for painful bladder syndrome/interstitial cystitis (PBS/IC), which is currently an incurable disease. The purpose of this systematic review was to evaluate the treatment effects of CyA in PBS/IC. Electronic and manual retrieval procedures were carried out to identify eligible references for the systematic review. The entire contents of the included articles were assessed, from study design to reported results. Eight studies, comprising three randomized controlled trials (RCTs), four prospective studies and one retrospective cohort study, were included, involving a total of 298 subjects. Meta-analysis was not implemented due to heterogeneity of the manner of reporting the outcome parameters. All studies reported an improvement in symptoms following treatment with CyA. The results of the three RCTs implied that the treatment effects of CyA were better than those of pentosan polysulfate sodium. Some adverse events, for example, elevation of serum creatinine levels and an increase in blood pressure, were noted in five studies. In conclusion, the evidence from the studies implied that treatment of CyA can result in a long-term benefit in patients of PBS/IC; however, further evidence is required to verify this.

Inhibition of peptidyl‑prolyl cis‑trans isomerase B mediates cyclosporin A‑induced apoptosis of islet β cells

“…Cyclophilins are a family of proteins present in vertebrates and other organisms. They bind to CsA, an immunosuppressant that is commonly used to suppress rejection after organ transplantation ( 19 – 20 ). The molecular mechanisms of CsA-induced β cell apoptosis probably involve the downregulation of cyclophilins.…”

Interstitial Cystitis/Bladder Pain Syndrome

“…[182][183][184][185][186] Of note, the benefits of the low-dose cyclosporine A reportedly used must be weighed against side effects such as hypertension and renal function impairment, which appear to resolve after discontinuation, at least in the short term. [186][187][188] The sixth and final line of therapy is more radical surgical treatment such as diversion with or without cystectomy and substitution cystoplasty. Very few patients will ever progress to this level of treatment, but small studies suggest that this can relieve patients of irritative voiding symptoms and particularly may be useful for those with a fixed small bladder capacity.…”

Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review

“…The authors concluded that treatment with CyA could potentially result in long-term benefit; however, further evidence is required to confirm these findings. 45 CyA may be dosed at 2 mg/kg divided into twice daily (bid) dosing and drug levels should be monitored. Side effects are common, and patients must be monitored for renal impairment, hepatic impairment, electrolyte abnormalities, hypertension, and infection.…”