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Is Botulinum Toxin the Best Intravesical Treatment for IC?

Zhang W, Deng X, Liu C, Wang X. Intravesical treatment for interstitial cystitis/painful bladder syndrome: a network meta-analysis. Int Urogynecol J. 2016 Sep 10. [Epub ahead of print]

Intravesical instillation is a treatment strategy where a specific agent is delivered directly to the bladder using a catheter. There are several different intravesical treatments available for interstitial cystitis/bladder pain syndrome (IC/BPS); these include botulinum toxin A, bacillus Calmette-Guerin (BCG), lidocaine, chondroitin sulfate, and pentosan polysulfate, among others. There are various studies suggesting that all of these treatments can provide some relief of symptoms. However, it’s still unclear whether any of these therapies is better than the others when delivered intravesically. Accordingly, these researchers conducted a meta-analysis of 16 clinical trials representing 905 patients. In particular, they sought to compare Global Response Assessment (GRA), a measure used as an endpoint in many IC/BPS trials today. Botulinum toxin and BCG both provided significant improvement in GRA, but it was botulinum toxin that had the greatest probability of being the best treatment course, according to the investigators. Botulinum toxin also significantly improved bladder capacity. Of note, the analysis also revealed that pentosan polysulfate significantly improved both urinary frequency and urgency symptoms. While the findings do suggest some intravesical treatments are superior to others, further studies (particularly ones comparing the treatments head-to-head) would provide better insights into the relative efficacy of intravesical treatments for IC/BPS.