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New concepts emerge for treatment of IC.(interstitial cystitis )
SAN ANTONIO -- Highly effective treatments for interstitial cystitis remain elusive, but new concepts are enlivening the field, Deborah R. Erickson, M.D., said at the annual meeting of the American Urological Association.
Some of the concepts build on old ones, while others are completely new. But all are off-label, and with two exceptions they have not been subjected to placebo-controlled trials, cautioned Dr. Erickson, of the University of Kentucky (Lexington).
Here is a rundown of some interstitial cystitis (IC) treatment concepts she presented at the meeting:
* Finding ways to restore the deficient bladder epithelium is an old approach; several drugs are being developed with this in mind, but none is yet available.
* Another old concept focuses on mast cells--either inhibiting mast cell activation or blocking mast cell mediators. Ketotifen, a mast cell stabilizer, has proved effective when used topically in the eye and may be developed for IC. Montelukast, a leukotriene receptor blocker, has been the subject of one open-label trial in IC. Among 10 patients with IC and detrusor mastocytosis who had at least 28 mast cells per square millimeter of muscle tissue, 3 months of treatment with montelukast was associated with significant improvements in nocturia, day voids, and pain scores (J. Urol. 2001;166:1734-7).
* Immunosuppression is another old concept that's getting a fresh look. Until now, immunosuppression has not been popular for treating IC because it's too risky to apply to all patients, it's unclear which patients would do best with this strategy, and it's unclear when treatment can be stopped.
Patients with evidence of inflammation or autoimmune involvement may do best on immunosuppression. Such patients include those with the ulcer type of IC, those with evidence of inflammation on bladder biopsy, and those with high levels of urine mediators such as interleukin-6. High levels of nitric oxide gas also suggest inflammation, but special equipment is needed to measure gas levels.
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