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Treatment of IC/BPS Remains Challenging Due to Lack of Biomarkers

Belknap S, Blalock E, Erickson D. The Challenges of Interstitial Cystitis: Current Status and Future Prospects. Drugs. 2015 Dec;75(18):2057-63. doi: 10.1007/s40265-015-0504-9.

This review for clinicians outlines the conundrum of treating IC/BPS with currently available therapies. The core of the issue is that IC/BPS is thought to develop from one of several potential causes: dysfunction of the bladder urothelium, inflammation of the bladder, or the presence of neuropathic pain. In order to ameliorate the condition, the clinician is essentially aiming a treatment at one of these potential causes. Several examples are provided: for example, glycosaminoglycans are aimed at the bladder urothelium issue, while on the other hand, mast cell stabilizers are aimed at treating neurogenic inflammation. Despite such attempts, treatment often fails, which means that either the treatment targeted the wrong cause, or the treatment wasn’t potent enough to ameliorate the cause. It would be ideal if doctors and other clinicians could make this distinction; if so, then a wrongly targeted treatment could be quickly discontinued, and a correctly targeted treatment could be confidently intensified. There is hope that researchers will identify biomarkers in the blood or urine that help identify each particular cause of IC/BPS. The appearance of such a biomarker in the patient’s blood or urine would help the clinician more rationally choose a treatment that would be likely to help that particular patient.