Intravesical Chondroitin Sulphate Shows Promise For Treatment Of Bladder Pain Syndrome

Main Category: Urology / Nephrology
Also Included In: Pain / Anesthetics
Article Date: 13 Oct 2008 - 4:00 PDT

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UroToday.com - One of the best studied 'naturally occurring' glycosaminoglycans in bladder pain syndrome has been chondroitin sulphate. Studies have indicated a deficit of this proteoglycan in the bladder uroepthelium in BPS. Curtis Nickel from Kingston, Ontario and his Canadian colleagues reported on a multicenter, community based, open-label, uncontrolled study designed to assess the efficacy and safety of intravesical sodium chondroitin sulphate for BPS.

The less-restrictive National Institutes of Health Interstitial Cystitis Database Study definition of interstitial cystitis was the operative definition. Patients must have had urinary/bladder pain/discomfort and urinary frequency/urgency persisting for more than 24 weeks with a negative urine culture and no other obvious cause for the symptom complex. Two percent solution of sodium chondroitin sulphate was instilled by urinary catheter weekly for 6 weeks and then monthly for 16 weeks. A seven point global response assessment was the primary endpoint requiring marked or moderate improvement to qualify as a success.

In all, at week 10, 47% of patients were responders. The O'Leary Sant symptom score decreased by a mean of 5 points and the O'Leary Sant problem score decreased by a mean of 4.3 points. The responder rate increased to 60.4% at week 24. Twenty-eight patients reported 65 adverse events, all mild, and only 20 of those were considered possibly related to treatment. No safety issues were identified.

While open-label trials are notoriously unreliable in the study of BPS treatments, this study does show proof of concept and suggests the need and rationale for a well-powered, randomized, placebo-controlled trial of intravesical chondroitin sulphate for BPS.

Nickel JC, Egerdie B, Downey J, Singh R, Skehan A, Carr L, Irvine-Bird K
BJU Int. 2008 Sep 3. Epub ahead of print
10.1111/j.1464-410X.2008.08028.x

Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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