ELMIRON

Background

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In an article published in Urology in November 2018, Elmiron has experienced sales of over $150 million per year, despite limited efficacy. 

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In a study, published in the Journal of Urology in March 2015, a randomized, double-blined, placebo controlled study found that, “There was no statistically significant difference between the pentosan polysulfate sodium group and the placebo group or between the 2 pentosan polysulfate sodium groups for the primary end point, defined as responder achieving a 30% or greater reduction from the baseline ICSI total score at study end.”   Janssen’s own website states, “it is not known exactly how Elmiron works”.

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Used to treat interstitial cystitis, which is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain.  IC is a common ailment among folks in the U.S. with more than 200,000 cases per year.  Women are up to 4 times more likely to suffer the condition than men, however, it is believed that the condition in men is underreported due to often being mistaken for another disorder, such as chronic prostatitis/chronic pelvic pain syndrome.

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According to Navamedic.com: Elmiron had approximately 330,000 prescriptions and more than $250 million in annual U.S. sales (FY2016).

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Treatment / Use

 

According to Janssen website, “ELMIRON® is a prescription medication used to treat the bladder pain or discomfort associated with interstitial cystitis (IC). It is not known exactly how ELMIRON® works, but it is not a pain medication like aspirin or acetaminophen and therefore must be taken continuously for relief as prescribed by your doctor.”

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According to Drugs.com, Elmiron (sodium pentosan polysulfate) works like an anticoagulant (blood thinner) that prevents the formation of blood clots. However, it is used to treat bladder pain and discomfort caused by cystitis (bladder inflammation or irritation).

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Interstitial Cystitis or Bladder Pain Syndrome (IC/BPS) affects an estimated 1.3 million Americans (2017).  Elmiron is the ONLY drug approved to treat IC/BPS.

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Injuries / Complications / Concerns

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In Spring 2018, Dr. Neiraj Jain and colleagues wrote a letter to the editor of the Journal of Urology to alert readers to a concerning new observation of vision threatening retinal changes associated with long-term exposure to PPS (pentosan polysulfate sodium).

 

 

The first clinical population based study found 24% of patients showed eye damage, and that the damage increased with the quantity of Elmiron taken.

 

 

The first national multicenter study showed no significant association at 5 years of use, but at 7 years, Elmiron users had significantly increased odds of having the atypical maculopathy outcome (OR=1.41, 95% CI 1.09 to 1.83, p=0.009).

 

 

Another study reported, “the present case adds a new layer of concern by demonstrating progressive maculopathy continuing for up to 6 years after the cessation of PPS (Elmiron).

 

 

Conditions or warning signs of maculopathy include: difficulty reading, taking a long time to adjust to the dark, difficulty seeing close objects, dimming vision, paracentral scotoma (a spot of vision loss in the field of vision).

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In June 2020, Janssen changed the label to include “Retinal Pigmentary Changes”.

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Other indicators include:

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Hyperpigmented, dark spots on the retina that can be observed during an eye examination

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Parafoveal pigmented deposits – vision loss may occur because of an abnormal effect on the capillaries and small blood vessels around the macula

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Vitelliform deposits – these are round, somewhat yellow lesions under the macula, also known as adult pattern macular dystrophy

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Retinal pigment epithelium atrophy – this is common with age-related macular degeneration

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