A Powerful Drug Finds a New Use in Treating Interstitial Cystitis

In an earlier life I was involve in the development of cyclosporine, the first immunosuppressive that allowed the widespread use of kidney, lung, and heart transplants.  Cyclosporine carries a number of severe or unpleasant side effects, and it’s not usually prescribed except to prevent transplant rejection.  But a presentation at the recent American Urological Association meeting described a small group of patients with painful, treatment-refractive interstitial cystitis who were treated with cyclosporine with considerable success.   

Oklahoma researchers gave 19 patients with treatment-resistant interstitial cystitis and chronic pelvic pain syndrome for at least one year.  There were 12 women and 7 men with an age range of 44 to 71. Fourteen of them had an average 70% improvement in their overall symptoms.  The rest were non-responders or could not tolerate the side effects of cyclosporine – fatigue, muscle ramping, or lab abnormalities.  In most subjects, the symptoms responded quickly and, sometimes, dramatically. Urination at night decreased from averages of 5 times per night to 2 per night; hemorrhagic cystitis patients stopped bleeding. 

If cyclosporine was reduced in dosage, symptoms recurred.  Thus prolonged (lifetime?) treatment with a powerful immunosuppressant seems likely – a risk that many patients with this distressing disease would accept.      

Cyclosporine for transplants has largely been replaced by better, less toxic drugs.  It’s possible one of these would also be effective in interstitial cystitis.  The disease is not common enough for large drug companies to develop a drug especially for it – this would be uneconomical.  But there’s hope that one or other immunosuppressant will be able to help these patients.