Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.
Can J Urol. 2023 Dec;30(6):11740.
How should a conscientious physician advise patients with Interstitial Cystitis /Bladder Pain Syndrome (IC/BPS) when they want to know if taking Pentosan Polysulfate Sodium (PPS) will lead to loss of vision? Ever since the initial report from Pearce et al in 2018 suggesting that PPS usage can lead to the development of pigmented maculopathy (PM), my patients have been inundated with solicitations from attorneys looking to sign up clients for class action lawsuits.1 While there have been additional reports suggesting a relationship between PPS exposure and the development of PM, Ludwig et al found that there was no difference in the rate of macular disease between patients with documented IC/BPS who had taken PPS and those with IC/BPS with no history of PPS use.2 The large size of Ludwig's study certainly suggests that PPS may not cause PM to develop, and if the rate of PM in the IC population is higher than in controls, it may be due to the disease itself and not from the medication. In this manuscript, Proctor clearly describes the immune inflammatory response that is responsible for the development of the bladder damage seen with IC/BPS. Also, he describes how inflammatory mediators can enter the blood stream and might be a potential cause for the development of PM.3 This is a thought-provoking hypothesis that demands further evaluation. I have prescribed PPS since its approval and have many patients who feel it is an essential part of their IC treatment regimen. There is no other prescription medication that functions in the same fashion. I require them to follow the FDA recommendations for annual eye exams to look for PM development. I also advise patients that as they improve, we will discuss dose reduction and even discontinuation if their IC symptoms have abated. By following these suggestions, one should be able to continue to prescribe PPS for appropriate patients while carefully monitoring them for PM. I found this article extremely informative and will refer to it when counseling patients about IC/BPS and PPS.
当有责任心的医生被问及是否会因服用戊聚糖多硫酸酯钠（PPS）而导致失明时，应该如何向患有间质性膀胱炎/膀胱疼痛综合征（IC/BPS）的患者解释？自从 Pearce 等人在 2018 年首次报告称 PPS 的使用可能导致色素性黄斑病变（PM）以来，我的患者就收到了大量律师招揽他们代理集体诉讼的请求。1 虽然有其他报告表明 PPS 暴露与 PM 的发展之间存在关联，但 Ludwig 等人发现，有记录的 IC/BPS 患者中有服用 PPS 史的患者和无 PPS 使用史的 IC/BPS 患者之间黄斑疾病的发生率没有差异。2 Ludwig 的研究规模很大，这表明 PPS 可能不会导致 PM 发生，如果 IC 人群中 PM 的发生率高于对照组，这可能是由于疾病本身，而不是药物引起的。在这篇论文中，Proctor 清楚地描述了导致 IC/BPS 所见膀胱损伤的免疫炎症反应。他还描述了炎症介质如何进入血液，可能是 PM 发展的潜在原因。3 这是一个发人深省的假说，需要进一步评估。自从 PPS 获得批准以来，我一直在开具 PPS，我有很多患者认为它是他们 IC 治疗方案的重要组成部分。没有其他处方药物具有相同的作用。我要求他们按照 FDA 的建议进行年度眼科检查，以检查 PM 的发展。我还建议患者，随着他们病情的改善，如果他们的 IC 症状减轻，我们将讨论减少剂量，甚至停药。通过遵循这些建议，在仔细监测 PM 的情况下，应该能够继续为合适的患者开具 PPS。我发现这篇文章非常有启发性，在为患者提供 IC/BPS 和 PPS 咨询时，我会参考这篇文章。
