tacrolimus and Cystitis--Interstitial

Topics: Botulinum Toxins, Type A; Cystitis, Interstitial; Humans; Pelvic Pain; Pilot Projects; Tacrolimus

Interstitial cystitis/Bladder pain syndrome (IC/BPS) is a chronic condition with limited effectiveness of current treatments without any cure. Cyclosporine A is effective in intractable cases of BPS/IC. Tacrolimus has same mechanism of action. The purpose of this pilot study was to find if tacrolimus instilled in bladder is effective in treating BPS/IC without side effects.. From February 2013 till Dec. 2017 tacrolimus dissolved in DMSO/sterile water was instilled in bladder of 24 patients of intractable BPS/IC. Patients received one to six cycles of therapy at interval of 14 days. Base line complete blood count, blood glucose, renal and liver function test were done and repeated after every three instillations. Serum tacrolimus level was also measured in 10 patients. Primary study endpoint was Global Response Assessment (GRA) score.. 13 out of 24 patients showed improvement in a follow up extending from 6 to 63 month. Except for post- instillation flare in symptoms no side effects were observed in the patients during follow-up. Blood levels of tacrolimus reach same safe level irrespective of using either DMSO or water for preparing the solution.. Intravesical tacrolimus dissolved in DMSO/water has been found effective in 54% patients of intractable BPS/IC without significant side effects in this pilot study. For the first time we have discovered that though tacrolimus is believed to be insoluble in water it gets absorbed by bladder urothelium when a solution of tacrolimus in water is instilled in urinary bladder. It should be offered to the patients before offering surgery.

Topics: Administration, Intravesical; Cystitis, Interstitial; Female; Humans; Immunosuppressive Agents; Male; Pain Measurement; Pelvic Pain; Pilot Projects; Tacrolimus; Treatment Outcome; Urinary Bladder

Topics: Cystitis, Interstitial; Humans; Pelvic Pain; Pilot Projects; Tacrolimus

We report a case of interstitial cystitis (IC) associated with primary Sjögren's syndrome (SS) successfully controlled with combination therapy of tacrolimus and a corticosteroid. In 2011, a 69-year-old female, who had been diagnosed with primary SS 23 years ago, developed IC and was successfully treated with tacrolimus and prednisolone combination therapy. The mechanism of IC, including the involved autoimmunity, has not been elucidated. Clinical observation studies suggest a potential association between SS and IC. However, IC is currently thought to be underdiagnosed in patients with SS as well as in the general population. Based on our case and others reported previously, IC associated with SS responds well to immunosuppressive therapy. In particular, a combination of a calcineurin inhibitor (tacrolimus or cyclosporine) with a corticosteroid seems to be highly effective. The possibility of IC in patients with SS complaining of lower urinary tract symptoms without features of infection or other identifiable causes should be given attention.

Topics: Adrenal Cortex Hormones; Aged; Cystitis, Interstitial; Drug Therapy, Combination; Female; Humans; Prednisolone; Sjogren's Syndrome; Tacrolimus; Treatment Outcome