Hyaluronic Acid in Urological Disorders:Treatment Rationale and Clinical Evidence at the EAU in Stoc
The annual congress that was held in Stockholm a few days ago provided an opportunity to examine the latest developments in treating interstitial cystitis with glycosaminoglycans
A combination of hyaluronic acid and chondroitin sulfate has recently given evidence of efficacy in the treatment of various forms of cystitis, both in the reduction of bacterial cystitis and in more complex forms such as interstitial cystitis. This latter condition is also known as pelvic pain syndrome, a chronic inflammatory state of which the etiopathogenetic mechanisms are not yet fully known, and of which the criteria for diagnosis have only recently been generally agreed.
Currently it is thought that cystitis occurs as a result of an alteration of the uroepithelium, the ‘inner lining’ of the bladder and urinary tract, and of its coating, which is in turn covered in a surface layer of glycosaminoglycans (GAGs) including hyaluronic acid and chondroitin sulfate, and a deeper layer of glycoproteins and proteoglycans. In physiological conditions, the coating prevents pathogens attaching to the uroepithelium. This protection no longer exists if the uroepithelium is damaged. The series of inflammatory neurogenic responses that follow ultimately result in the typical symptoms of cystitis.
The results of clinical studies
The efficacy of treating interstitial cystitis with a combination therapy of hyaluronic acid and chondroitin sulfate has been documented by a recent study carried out in six urology departments in Italy and coordinated by Prof. Mauro Cervigni of the Università Cattolica in Rome. The study compared treatment with a combination of hyaluronic acid and chondtroitin (HA+CS) with dimethyl sulfoxide (DMSO), one of the standard therapies for the pathology, approved by the FDA.
The patients comprised 110 women diagnosed with IC/BPS based on ESSIC criteria, who were treated randomly with 13 instillations of one of the above treatments for three months followed by an observation period of a further three months.
“There were improvements in symptoms such as the pain, frequency and urgency for both treatments being examined during the period of the study, but the combination of hyaluronic avid and chondtroitin sulfate gave the best outcomes, even if not statistically significant, in terms of pain measured using the VAS scale, and a smaller percentage of adverse events”, we were told by Prof. Cervigni, who went on, “The results of the intravesical therapy aiming to replace the GAGs indicates that replenishing the uroepithelium reduces the symptoms of cystitis, and the evidence of this study shows the usefulness of this therapeutic approach for these patients“.
The IBSA therapeutic proposal
In urology and urogynecology IBSA research has provided specialists with a solution of hyaluronic acid and chondroitin sodium sulfate. More recently, IBSA has developed a new formulation in soft capsules for oral administration, which in addition to the hyaluronic acid and chondtroitin sulfate, also contain quercetin and curcumin, natural plant-based substances with anti-oxidant properties.