Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects. Kay G, Crook T, Rekeda L, et al. Eur Urol 2006;50:317-26
• Oxybutynin is used not only by OAB patients but also by many PBS/IC patients. This study concludes that oxybutynin ER caused significant memory deterioration (magnitude of effect comparable to brain aging of 10 years). The results also demonstrate that subjects may not recognise/report memory deterioration and memory decline may be attributed wrongly to aging. The findings highlight a need for further studies to fully establish the effects of all OAB antimuscarinics on memory/cognition.
Editorial Antimuscarinics and cognitive function. De Ridder D.
Eur Urol 2006;50:211-2
• in this editorial, the author adds that in many countries, for financial reasons, the older and cheaper oxybutynin will still be the treatment of choice
A
prospective, randomized, placebo controlled, double-blind study
of amitriptyline for the treatment of interstitial cystitis. van Ophoven A, Pokupic S, Heinecke A, et
al. J Urol 2004;172:533-6 • the authors conclude that amitriptyline therapy for 4 months is safe and effective for treating IC • a statistically significant change in the symptom score and statistically significant improvement of pain and urgency intensity compared with placebo were observed
• anticholinergic side effects constitute the major drawback of amitriptyline treatment for IC
Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis. Warren JW, Horne LM, Hebel JR, et al. J Urol 2000;163:1685-8
• 50 patients with IC were randomized to receive 18 weeks of placebo or antibiotics, including rifampin plus a sequence of doxycycline, erythromycin, metronidazole, clindamycin, amoxicillin and ciprofloxacin for 3 weeks each.
• 12 of 25 patients (48%) in the antibiotic and 6 of 25 (24%) in the placebo group reported overall improvement (p = 0.14), while 10 and 5, respectively, noticed improvement in pain and urgency (p = 0.22).
• in the antibiotic group 20 participants (80%) had adverse effects compared with 10 (40%) in the placebo group (p = 0.009).
• the authors conclude that their findings suggest that these antibiotics alone or in combination may sometimes be associated with decreased symptoms in some patients but they do not represent a major advance in therapy for interstitial cystitis
A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. Cartledge JJ, Davies AM, Eardley I. BJU Int 2000;85:421-6 • the authors conclude that oral L-arginine produces a statistically significant improvement in the IC symptom index in patients with IC, but the effect is small; this effect may not be clinically significant as there were no improvements in the other variables assessed and no significant difference between the response to L-arginine and placebo
• from these results the use of L-arginine cannot be recommended for treating IC
A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease. Holm-Bentzen M, Jacobsen F, Nerstrom B, et al. J Urol 1987;138:503-7 • protocol A included 43 patients with clinically and pathologically anatomically verified interstitial cystitis (28 or more mast cells per mm.2)
• protocol B included 72 patients with a painful bladder and unspecific histological findings
• patients were randomized to receive either sodium pentosanpolysulfate (200 mg. twice daily) or placebo capsules for 4 months
• before and after the trial the patients were evaluated with symptom grading, urodynamics and cystoscopy with distension and deep bladder biopsies
• the results showed no difference between the pre-trial and post-trial values in the sodium pentosanpolysulfate and placebo groups in both protocols in regard to symptoms, urodynamic parameters, cystoscopic appearance and mast cell counts.
• a significant increase in the cystoscopically determined bladder capacity in the sodium pentosanpolysulfate group in protocol A was found
• the authors conclude that no statistically or clinically significant effect of sodium pentosanpolysulfate was found compared to placebo in patients with painful bladder disease
open studies and non-placebo-controlled studies
The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observatinal study. van Ophoven A, Hertle L.J Urol 2007;177:552-5
• in this observational study, duloxetine was given for two months to 48 women with IC according to the NIDDK criteria
• 5 patients (10.4%) responded and 17 (35.4%) dropped out due to nausea
• patients who responded reported onset of improvement but not until they had reached the target dose of 2x 40 mg per day
• the authors conclude that
duloxetine did not result in significant improvement of symptoms in patients with IC
Long-term results of amitriptyline treatment for interstitial cystitis. van Ophoven A, Hertle L. J Urol 2005;174:1837-40 • the authors conclude that long-term
administration of amitriptyline is a safe and effective treatment
for IC, provided that the drug is used judiciously to minimize
adverse effects
Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Nickel JC, Barkin J, Forrest J, et al. (Elmiron Study Group). Urology 2005;65:654-8 • for all three dosages of oral PPS (300,
600, and 900 mg), a clinically significant but similar response
was demonstrated
• the duration of therapy appears to be more important than the dosage
• a limitation of this study is the lack of a placebo group
A novel highly effective treatment of interstitial cystitis causing chronic pelvic pain of bladder origin: case reports. Check JH, Katsoff B, Citerone T, Bonnes E. Clin Exp Obstet Gynecol 2005;32:247-9
• two women with interstitial cystitis that had been refractory to various therapies were treated with dextroamphetamine sulfate
• both patients quickly improved their bladder symptoms, all pain and urgency was gone within a week and the IC remission as long as the women stayed on their medication
reviews
Pharmacologic management of painful bladder syndrome/interstitial cystitis: a systematic review. Dimitrakov J, Kroenke K, Steer WD, et al. Arch Intern Med 2007;167:1922-9. • over 180 different therapies have been tried for PBS/IC, yet evidence from trials remains inconclusive
• this study concludes that PPS may be modestly beneficial for PBS/IC
• there is insufficient evidence for other pharmacologic treatment
• a consensus on standardized outcome measures is urgently needed
Efficacy of interstitial cystitis treatments: a review. Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J. EAU-EBU Update Series 2006;4:47-61
• in this article, the degree of evidence regarding the clinical efficacy of available interstitial cystitis treatment options is reviewed
• only three therapies are supported by a high level of evidence: oral cimetidine and amitriptyline and the intravesical dimethylsulfoxide (DMSO)
Chondroitin sulfate for interstitial cystitis. Palylyk-Colwell E. Issues Emerg Health Technol 2006 May;(84):1-4
• this review concludes that two non-randomized, uncontrolled pilot studies reported improvements in patient-reported symptoms after the use of chondroitin sulfate for one year
• the author also concludes that prospective, randomized, head-to-head trials are needed to assess the effectiveness of this technology compared with other IC therapies
Antidepressants and cognitive-behavioral therapy for symptom syndromes. Jackson JL, O'malley PG, Kroenke K. CNS Spectr 2006;11:212-22
• this article reviews the randomized controlled trial data for the use of antidepressant and cognitive-behavior therapy for 11 somatic syndromes: irritable bowel syndrome, chronic back pain, headache, fibromyalgia, chronic fatigue syndrome, tinnitus, menopausal symptoms, chronic facial pain, noncardiac chest pain, interstitial cystitis, and chronic pelvic pain
updated
23.11.2007 10:20