Comparison of Interstitial Cystitis Treatment Pathways One Year After Diagnosis

Objectives: Established treatment guidelines for interstitial cystitis (IC) are multi-modal and have long been established as viable options, there is a lack of literature describing the frequency with which different treatments are utilized and the timeline to trial of other options within algorithm after the diagnosis of IC. This study's objective was to explore the various IC treatment pathways using a large multisite cohort analysis.

Methods: Database analysis using TriNetX combined deidentified medical records from over 60 health systems worldwide for comparison using ICD10/CPT codes. Cohort selection included female patients (>17 years) with a diagnosis of IC. An analysis time frame included from first diagnosis of IC by ICD10, the index event, extending to one year. Treatment characteristics included evaluation of the initiation of treatment and subsequent change in treatment pathways that each patients underwent. The initial comparison identified the proportion of patients who were initiated on various treatments or combinations of treatments as first, second, third line of treatment and beyond. Additional comparisons of the number of patients initiated on specific treatments and the time and number who then switched to a different treatment option.

Results: A total of 83,743 patients met the inclusion criteria with an average age at diagnosis of IC of 48±17.3 years (range 18-90). The majority of the cohort was white (76.5%), followed by unknown race (11.1%) and black (6.2%). 26,782 patients had identifiable treatment pathways started with cystoscopy with bladder hydrodistension, intravesical instillations, oral medications, or some combination of treatments. The majority, 67%, of these patients were initiated on some oral medication (Labeled as ‘O’ in Table 1 and representing amitriptyline, hydroxyzine, cimetidine, or pentosan polysulfate) as first line with an average time to treatment initiation of about 48 days and only 8% of this group switched to a different treatment option (Table1). Figure 1 shows the percentage of patients who received a treatment as first line (LOT1), second line (LOT2), etc. Table 1, also identifies those who initially received cystoscopy with bladder dilation, intravesical instillations, or a combination of both (Labeled ‘C’, ‘I’, or ‘C+I’, respectively) and 13-27% of patients switched to a different treatment pathway within the first year. The specific treatment pathways that patients underwent are noted in Table 1(a singular switch in Group 2 and two separate switches in Group 3) and represented by a “->” delineates the specific treatment pathway occurred.

Conclusions: Those started on medication as initial treatment had notably lower rates of switching to other treatment options within the first year of IC diagnosis. This treatment approach aligns with the AUA guidelines that favor beginning with a more conservative approach with changing of treatment approaches pending patient response. This data is limited by the potential for other indications for medication treatment.