Efficacy and safety or botulinum toxin injection for interstitial cystitis/bladder pain syndrome: A dystematic review and meta-analysis

초록

Hypothesis / aims of study To investigate the overall treatment efficacy and safety of botulinum toxin type A (BTXA) injections compared with placebo in interstitial cystitis/bladder pain syndrome (IC/BPS). Study design, materials and methods We conducted a systematic review and meta-analysis of the published literature in PubMed, Cochrane Library, and Embase on BTX use in IC/BPS. Outcome measures included changes of OLS, ICSI, ICPI, VAS, frequency, nocturia, FBC, Qmax, and PVR from baseline, and also included adverse events. Results A total of five studies were included, with a total sample size of 252 subjects (133 subjects in the experimental group and 119 subjects in the control group). The duration of treatment ranged from 8 to 12 weeks. The BTX dosage was from 50 U to 200 U. The pooled overall SMD in the mean change of VAS for the BTXA group versus the placebo group was -0.50 (95% CI; -0.75, -0.24). There were also significant improvements in ICPI and frequency. The other outcomes (ICSI, nocturia, Qmax, and FBC) were not statistically different between the two groups. Interpretation of results Although evidence from clinical and basic research studies supports the use of BTXA in IC/BPS, no general consensus has been made regarding its application. The present study showed that subjective indexes such as OLS, ICPI, and VAS were significantly improved following BTXA treatment compared to treatment with a placebo. Concluding message This first evidence-based systematic review and meta-analysis of BTXA injection for IC/BPS showed significant differences in efficacy of treatment compared with placebo, especially for pain control, and also showed no differences in the rate of procedure-related adverse events.