Pentosan Polysulfate Sodium and Maculopathy in Patients with Interstitial Cystitis: A Systematic Review and Meta-Analysis

Purpose: Pentosan polysulfate sodium (PPS) is the only pharmacological intervention approved by the US Food and Drug Administration for treating interstitial cystitis (IC) to date. However, PPS may induce an adverse event, maculopathy, which can be a significant challenge. To determine the risk of PPS-induced maculopathy in patients with IC. Materials and Methods: PubMed and Embase were systematically searched through July 2024. Two authors also independently and manually searched all relevant studies. We included national level cohort studies using healthcare claim big data or real-world data with the following criteria: (1) patients diagnosed with IC; (2) interventions included PPS as an active treatment; (3) comparisons were specified as non-PPS interventions; and (4) the primary outcome of interest was the risk of maculopathy. The pairwise meta-analysis was performed to compare the PPS treatment group with control used in IC. The primary outcome measure was the hazard ratio (HR), odds ratio (OR), and proportional report ratio (PRR) of maculopathy after receiving the PPS treatment, as compared to non-PPS interventions. Results: A comprehensive literature search was conducted, and identified 6 studies with 411,098 patients. The pooled risk for maculopathy due to PPS in patients with IC was significant (HR, 1.678; 95% confidence interval [95% CI], 1.066-2.642]). The heterogeneity test produced a Higgins' I-squared statistic, which was 83.6%. In the subgroup analysis of follow-up period of less than 5 years (HR, 1.285; 95% CI, 1.139-1.449) and more (HR, 1.341; 95% CI, 1.307-1.375) were statistically significant, indicating that the patients with IC who had a long-term PPS treatment were more likely to have maculopathy than the control groups. Conclusions: This is the first study to investigate the relationship between PPS and its association with the risk of maculopathy in patients with IC through a systematic review and meta-analysis.