AUA 2016: Oral cyclosporine for interstitial cystitis, efficacy, side effects and impact of clinical phenotype on outcomes

The AUA guideline on interstitial cystitis has identified Cyclosporine A as 5th tier therapy.  However, clinicians seldom use it due to concerns over side effects and efficacy.  Previous research on Cyclosporine did not clinically phenotype patients and often used Cyclosporine trough levels to determine drug exposure. 

The aim of the study was to assess the effects of Cyclosporine therapy in patients with recalcitrant interstitial cystitis (IC).  Patients who enrolled in this study had a clinical diagnosis of IC and had failed at least 2 prior classes of therapy.  All were clinically phenotype with UPOINT.  Patients were treated with Cyclosporine starting at 3 mg/kg divided twice a day and assessed monthly for 3 months to determine therapy.  Symptom response was a 7 point global response assessment in the Interstitial Cystitis Symptom Index.  Cyclosporine was monitored by renal function, serum creatinine and nuclear GFR.  Cyclosporine level was measured 2 hours after the morning dose.  26 patients were enrolled and 19 were available at 3 month primary endpoint.  There were 14 females, mean age was 50 years leading to symptom duration of 66 months.  7 patients (27%) had Hunner’s ulcers and 9 patients (34.6%) were on chronic narcotics.  At the 3 month primary endpoint, 52.4% of patients were improved by GRA and 38.1% had a > 30% improvement in overall Interstitial Cystitis Symptom Index.  The authors concluded that based on several different parameters Cyclosporine can be effective therapy for patients with longstanding recalcitrant IC who had failed multiple prior treatments and were refractory to other treatments.  This drug can also be successful in patients on chronic narcotics.  Patients with Hunner’s ulcers were unlikely to respond.  

Presented by: Shoskes, et al at 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA

Written by:  
Diane K. Newman, DNP, Adjunct Professor of Urology in Surgery, Research Investigator Senior and Co-Director, Penn Center for Continence and Pelvic Health

University of Pennsylvania, Division of Urology, 3400 Spruce Street, 3rd Floor Perelman Bldg, Philadelphia, PA. 19104