Cyclosporine shows 'dramatic' results in severe interstitial cystitis

São Paulo, Brazil-For the first time in years, patients with interstitial cystitis, especially those with the worst cases, may have an effective new treatment. Not only did three clinical studies of the immunosuppressant cyclosporine (Gengraf, Neoral, Sandimmune) presented at the AUA annual meeting in Anaheim, CA, show remarkable results, but two of them also pointed to markers that could be used to indicate which patients might benefit and whether the therapy is working. These studies and research on potential new markers of IC also may revive an autoimmune/inflammatory theory of the etiology of IC and may lead research in fruitful new directions (also see, "Is IC an autoimmune disease?").

The study that raised the most eyebrows came from the School of Medicine, State University of São Paulo, Brazil. It included 36 patients (34 women, two men; mean age, 46 years) who not only met the National Institute for Diabetes and Digestive and Kidney Diseases research definition of IC, but who also had the maximum score, 36 points, on the O'Leary-Sant Symptom and Problem In-dexes and who had undergone more than 15 different types of medical treatment without success. None elected to pursue more invasive options, such as cystectomy.

"Those are extremely dramatic results in that patient population," remarked John Forrest, MD, clinical associate professor of urology at the University of Oklahoma Health Science Center, Tulsa, and a member of the Urologic Specialists of Oklahoma, Inc. "The symptom improvement was good, but changed the patients from maximally symptomatic to moderately symptomatic, with modest improvement in bladder capacities."

Dr. Forrest asked whether the Brazilian team had used cyclosporine in earlier, less-symptomatic patients.

"The next protocol in our group is to use cyclosporine in milder cases," Dr. Chade responded, noting that his practice even uses the drug as first-line treatment.

"We think this drug may be really successful in this treatment, but we need to treat in an academic series first before we give this to the community," he told Urology Times.