Interstitial cystitis research signals big changes ahead in treatment

Key Points

Signs of the sea change to come in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) will be part of the 2012 AUA annual meeting. Next year should bring even more, as the National Institute of Diabetes and Digestive and Kidney Diseases and pharma research get readied for meeting debuts.

One of the most exciting is just a phase I, open-label safety and dose-ranging study, but investigators are already enthusiastic about the results they've seen with the LiRIS (lidocaine-releasing intravesical system) device. This "pretzel," not much bigger than a quarter, is inserted endoscopically and releases lidocaine continuously into IC bladders for a period of time-2 weeks in this study-before it is removed.

Studies review onabotulinumtoxinA

Two studies attendees will hear about in the IC podium session will give urologists more direction on how to use onabotulinumtoxinA (Botox) in patients with BPS. These studies elaborate on or support injection in the trigone only as the best approach to IC treatment with the toxin.

Russian investigators pitted trigonal onabotulinumtoxinA injection against hydrodistention in IC patients with Hunner's lesions. The results with onabotulinumtoxinA were just as good as with hydrodistention, and the group didn't see side effects that are major concerns with onabotulinumtoxinA injection, such as increased residual urine, decrease in uroflow, and upper tract retention.

"I would say that this paper adds important data that you don't have to inject all over the bladder," said Dr. Hanno.

In another onabotulinumtoxinA study, Portuguese researchers looked at urine concentrations of nerve growth factor (NGF), brain-derived nerve growth factor (BDNF), and glial cell line-derived neurotrophic factor (GDNF) before and after injection in patients with refractory IC. Two of the three, NGF and BDNF, showed potential as markers. Levels of these two growth factors tracked with pain levels, falling as pain levels fell at 1 month and rising again, as pain levels did, at 3 and 6 months.

Nothing is on the AUA program about the long ago reported-on potential marker antiproliferative factor (APF), but that doesn't mean that the research has stopped. Right now, the focus is on treatment. A phase I safety trial of an intravesical recombinant heparin-binding-EGF-like growth factor, the urothelium-building growth factor that may be able to counter APF, is beginning in Canada.