Cyclosporine Treatment For IC/BPS
Cyclosporine A has only been recommended as a treatment for IC/BPS since 2011. An immunosuppressant drug, it is widely used in organ transplantation to prevent rejection of new organ as well as in a variety of skin and eye disorders. It reduces the activity of the immune system by interfering with the activity and growth of T cells.
While IC/BPS is not generally considered an autoimmune condition, patients with Hunner’s lesions clearly have severe inflammation in their bladder biopsies. This is where cyclosporine treatment has been the most effective.
- In 2005, a randomized trial compared cyclosporine treatment with oral pentosan polysulfate (aka PPS, Elmiron). The patients receiving CyA (3 mg/ kg/day divided into two doses) resulted in 75% of patients experiencing clinically significant improvement compared to 19% of the Elmiron comparison group after six months of treatment. In addition, 38% of the CyA group reported a 50% decrease in frequency compared with 0% of the PPS group.(1)
- Two observational studies reported similar high rates of efficacy, including significant pain relief in 91% of patients after six weeks of treatment accompanied by decreases in frequency and increases in voided volumes145 and after an average one year of treatment, 87% of patients reporting that they were pain-free with similar improvements in voiding parameters.(2)
- In 2012, a study of 14 men and 30 women using cyclosporine was conducted. Of the 34 patients with Hunner’s lesions, 29 (85%) responded to treatment though six had to drop due to adverse events. The overall success rate was 68% for patients with lesions. In contrast, only 3 of 10 patients (30%) without lesions responded to treatment. The researchers concluded that Cyclosporine A was a viable treatment for patients who had failed other therapies. A 3 to 4 month trial is sufficient. Close monitoring of patients was needed due to the risk of adverse events, including changes in blood pressure and renal function. (3)
The key challenge with this medication is the potential for very severe adverse events, including:
- high blood pressure
- increased serum creatinine
The 2022 AUA Guidelines for the Diagnosis and Treatment of IC suggests that Cyclosporine is best used by patients struggling with Hunner’s lesions who did not respond to fulguration or triamcinolone therapy.(4,5) It is not concisely effective for patients without lesions.
- Sairanen J, et al. Cyclosporine A and pentosan polysulfate sodium for the treatment of interstitial cystitis: a randomized comparative study. J Urol 2005; 174: 2235.
- Forsell T, Ruutu M, Isoniemi H et al: Cyclosporine in severe interstitial cystitis. J Urol 1996; 155: 1591.
- Forrest JB, et al. Cyclosporine A for refractory interstitial cystitis/bladder pain syndrome: experience of 3 tertiary centers. J Urol. 2012 Oct;188(4):1186-91
- Clemens JQ et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 2022. Jul;208(1):34-42
- Osborne J. New IC/BPS Guidelines Released in May 2022. ICN. May 23, 2022
Author: Jill H. Osborne
Revision Date: 7/6/22