Nickel JC et al. (2008) Time to initiation of pentosan polysulfate sodium treatment after interstitial cystitis diagnosis: effect on symptom improvement. Urology 71: 57–61

Interstitial cystitis (IC) is a painful, chronic bladder syndrome that is often diagnosed late—partly because the symptoms are shared with common conditions—and treated after considerable delay. Although pharmacologic treatment has proven ineffective for many patients with IC, pentosan polysulfate sodium (PPS) seems to be beneficial. In a post-hoc analysis of data from a randomized trial, Nickel et al. examined whether the interval between diagnosis of IC and initiation of PPS (300 mg daily for 32 weeks) affected the extent of symptomatic improvement.

The researchers identified patients with IC who had started PPS either ≤6 months (early group; n = 57) or ≥24 months after diagnosis (late group; n = 46). Only 62 participants completed the trial, but completion rates were similar between groups. At baseline and 32 weeks, the severity and extent of nuisance from symptoms were assessed by the O'Leary–Sant IC Symptom Index (ICSI) and IC Problem Index (ICPI), respectively.

At baseline, ICSI and ICPI scores were similar between the early and late treatment groups. At 32 weeks, however, improvement in both scores was significantly greater in the early group than the late group; the same trend was identified in subgroups of patients in whom treatment was initiated ≤3 months or ≥36 months after diagnosis.

Limitations of the study were that time since diagnosis rather than time since symptoms began—probably longer—was used and that ∼65% of participants had received at least one IC-related medication before the trial; nevertheless, the findings support previous reports of the benefit of early pharmacologic treatment for IC.