BERKELEY, CA (UroToday Inc.) - Soucy and colleagues from Quebec, Canada performed a study to determine the efficacy of prednisone in the treatment of patients with refractory ulcerative IC. Their findings were published in the March 2005 edition of the Journal of Urology.

They studied 14 patients who met the IC Database eligibility study as originally described by Simon et al. (Urology 1997; 49:64). They had cystoscopic evidence of Hunner's ulcers and their patients were refractory to traditional therapies. These patients were started on prednisone 25 mg once a day for four to eight weeks and the dose tapered by 5 mg monthly to until the lowest dose that would give the patients symptomatic relief was reached. If the symptoms exacerbated the patients were retreated with 25mg of prednisone for 4 weeks. If after 2 months of treatment there was no benefit, then the medication was tapered and stopped. The O'Leary-Sant index was used to gauge the effectiveness of therapy, and patients underwent initial follow-up at one month and then every three to six months.

Of the 14 subjects, 2 were men, and the mean age of the patients was 65 years (range 51-76). Symptom duration prior to the study averaged 6.2 years, and the mean bladder capacity was 171 ml.

Mean follow-up in the study was 16.7 months (range 1-39 months), with 9 of 14 patients still using prednisone at the end of the study. Five patients were dropped from the study (4 due to poor response and 1 due to poor diabetes control).

Data from all 14 treated patients revealed a 26% decrease in the symptom portion and an 18% decrease in the problem portion of the O'Leary-Sant Index. The greatest change was seen in pain control, with a 69% reduction. In those 9 patients responding to therapy, there was an even more dramatic change with a decrease in the O'Leary-Sant Index of 38% and with an 88% improvement in pain.

No parameters were found that could be used to predict who would respond to treatment, and those who did respond to prednisone did so by at least 2 months. Four patients suffered from side effects of treatment, which included increased serum glucose levels, elevated blood pressure and pneumonia.

The authors conclude that the use of prednisone can be effective in improving symptoms, especially pain, in some patients with ulcerative IC who have failed to respond to standard therapies. A 2-month trial should be initiated, and if there is no improvement, therapy should be discontinued.

J Urol 2005; 173: 841-843