Immunomodulators for interstitial 15 cystitis/bladder pain syndrome

This chapter discusses systemic medicines that modulate the immune system, with the rationale that some cases of IC/BPS involve an inflammatory pathophysiology. Due to the significant risks of systemic immune suppression, it is essential to select patients who have the relevant pathophysiology. With current technology, this is best accomplished by cystoscopy and bladder biopsy. It also is essential to try less risky treatments first, and offer immunomodulation only when the less risky treatments fail. Of all immunomodulators previously studied for IC/BPS, only two are discussed in the American Urological Association guideline. First, the guideline recommends that long-term systemic glucocorticoids not be used. Second, the guideline lists cyclosporine A as a fifth tier treatment option (with the sixth and final tier being major surgery). This chapter summarizes the prior literature on immunomodulators previously investigated for IC/BPS and describes practical considerations for clinical use of cyclosporine A.