Low-Dose Steroids promising for treatment of Hunner-type interstitial cystitis

A new groundbreaking study revealed that low-dose oral prednisolone can significantly improve bladder pain, urinary symptoms, and quality of life in patients with Hunner-type interstitial cystitis (HIC). The study did not report any serious adverse events related to the low-dose prednisolone treatment. The study results were published in the journal European Urology Open Science.

Chronic bladder conditions can be incredibly debilitating, affecting a patient's quality of life and often defying conventional treatments. Among these conditions, Hunner-type interstitial cystitis (HIC) stands out as a particularly challenging and painful disorder. HIC is a chronic, immunological, and inflammatory disease of the bladder, characterized by severe pain, urinary symptoms, and a significant impact on patient's quality of life. However, a recent study has shed light on a potentially effective treatment for this condition that has long perplexed medical experts. 

A new retrospective observational study, conducted between 2016 and 2023, has examined the use of low-dose oral prednisolone (PSL) as a potential treatment for patients with refractory HIC. The study focused on 31 patients with refractory HIC who received daily doses of oral prednisolone, with an initial dose of either 5.0 or 7.5 mg, for at least 12 months. The dosage was adjusted to the minimum level required to maintain symptom relief throughout the follow-up period.

The study assessed treatment effectiveness through a seven-tier global response evaluation, where scores equal to or exceeding +2, indicating moderate or significant improvement, were considered indicative of a positive treatment response. Additionally, evaluations included the O'Leary and Sant symptom and problem indices (OSSI/OSPI), the overactive bladder symptom score (OABSS), an 11-point scale measuring pain intensity, a quality of life (QOL) score, and various variables derived from frequency-volume charts. The study also meticulously documented any associated complications.The study evaluated both the efficacy and safety of this treatment approach, producing encouraging results. 

Results: 

• The average follow-up duration was 20.1 ± 14.6 months.
• The overall response rates at 1, 3, 6, 9, and 12 months with prednisolone doses of 6.7, 6.7, 5.2, 4.0, and 3.0 mg were 38.7%, 48.4%, 54.8%, 61.3%, and 64.5%, respectively.
• Starting just one month after initiating prednisolone treatment, patients reported significant improvements in O'Leary and Sant symptom and problem indices (OSSI/OSPI) as well as pain intensity.
• Furthermore, additional benefits like the improvements in OABSS, QOL score, urinary frequency, and voided volume were significantly evident starting from the ninth month after the initiation of prednisolone therapy.
• Importantly, it's worth noting that no patients discontinued treatment due to adverse events.
• However, two patients did experience hypertension and glucose intolerance, although these issues were effectively resolved with temporary medications.
• Moreover, improvements in various symptom assessments was observed at different time points. 

In conclusion, this study offers renewed hope for patients suffering from the challenging condition of Hunner-type interstitial cystitis. The findings indicate that low-dose oral prednisolone can significantly alleviate the pain, urinary symptoms, and QOL issues experienced by individuals with HIC. Notably, this treatment approach appears to be safe, with manageable adverse events. To solidify these findings and provide more comprehensive insights into the potential efficacy and safety of low-dose prednisolone for HIC, prospective trials, and further research are warranted. 

Further reading: Akiyama Y, Niimi A, Nomiya A, et al. Efficacy and Safety of Low-dose Oral Prednisolone for Patients with Refractory Hunner-type Interstitial Cystitis. Eur Urol Open Sci. 2023;56:1-8. Published 2023 Aug 26. doi:10.1016/j.euros.2023.07.006