Cyclosporine Tested As Treatment for Difficult Interstitial Cystis Cases

A urologist told attendees of the American Urological Association 2011 annual meeting he has had promising results using cyclosporine A off-label to treat patients with severely symptomatic refractory interstitial cystitis (IC).

John B. Forrest, MD, Clinical Associate Professor of Urology at the University of Oklahoma Health Science Center in Tulsa, reported on a series of 22 IC patients who had been symptomatic for a long time and had failed all previous therapies. All had well documented autoimmune disease, such as lupus and rheumatoid arthritis. For these patients, the next step would be radical cystectomy. This was the impetus for trying cyclosporine A, he said. “I wanted to try something else before we took these patients’ bladders out,” said Dr. Forrest, who noted that patients were told of the risks and off-label nature of the treatment.

He said he used doses of cyclosporine A much lower than is used for immunosuppression in transplant recipients. The initial dose was 2 to 3 mg/kg/day divided into twice daily doses. After symptoms improved, the dose was decreased gradually as tolerated and adjusted based on adverse effects and serum cyclosporine A levels.

Dr. Forrest reported that 70% of patients reported at least a 75% improvement in their global symptoms. He also observed improvements in rheumatoid symptoms.

His experience with this series of patients should provide “some comfort level for the use of cyclosporine in this complex population,” he said.