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Barua JM, Arance I, Angulo JC, Riedl CR. A systematic review and meta-analysis on the efficacy of intravesical therapy for bladder pain syndrome/interstitial cystitis. Int Urogynecol J. 2015 Nov 20. [Epub ahead of print]

In this systematic review of published studies, investigators evaluated currently available intravesical (i.e. delivered directly to the bladder via a catheter) treatments for interstitial cystitis/bladder pain syndrome (IC/BPS). The treatments were evaluated both in terms of efficacy (how well they work) and pharmacoeconomic impact (how cost effective is the treatment). The authors of the analysis looked at 19 of the best published reports on intravesical therapy, including 5 prospective controlled trials; the reports included a total of 801 patients. Of all the agents, high molecular weight hyaluronic acid was the one with the strongest evidence of efficacy in terms of both positive response to treatment and reduction of symptoms. According to the investigators’ calculations, only 1.31 patients need to be treated to achieve a positive response to high molecular weight hyaluronic acid, compared with 2.67 patients for pentosan polysulphate, better known as Elmiron. Moreover, the hyaluronic acid treatment was superior to all other intravesical therapies in cost effectiveness. Despite these apparently positive results for high molecular weight hyaluronic acid, investigators cautioned that this is just a pooled analysis of unrelated studies–in order to conclusively show that any one intravesical treatment is significantly better than another, the two products would have to be evaluated in properly designed comparative studies.