Introduction: Oral cyclosporin-A (CyA) is a potential treatment of refractory Hunner lesion-interstitial cystitis/bladder pain syndrome (HL-IC/BPS). Due to its toxicity profile, patients on CyA require monitoring of serum CyA levels, renal function, and blood pressure, posing a barrier to widespread use. Despite being a Canadian Urological Association (CUA) guideline option, there is little experience using CyA for the treatment of refractory IC/BPS. We launched a pilot program using CyA for refractory HL-IC/BPS while implementing a strategy for ongoing quality improvement (QI) at Queen’s University.

Methods: A literature search was performed for studies using CyA for the treatment of refractory IC/BPS. Some authors were contacted directly for details regarding treatment and monitoring protocols. A transplant colleague at Queen’s University (MKS) with experience using CyA was consulted in protocol development for treatment and monitoring (Figure 1). The program was initially implemented exclusively for patients with refractory HLs. Following protocol development and initial pilot, a colleague with expertise in QI (GCD) was consulted regarding developing a continuous QI approach. A database has been created for program monitoring, evaluation, and QI. 

Results: To date, three patients are being treated with CyA through the program. The median length of treatment is seven months. Improvements in Interstitial Cystitis Symptoms Index and Interstitial Cystitis Problem Index at three months of followup have been dramatic for the first two patients (Figure 2), while the third has yet to complete initial followup. Dosage adjustments have been required in all patients due to supratherapeutic levels (x2) and side effects (x1). Collection of efficacy and quality of life data is ongoing.  

Conclusions: We have successfully developed and implemented a CyA program for the treatment of refractory HL-IC/BPS in Canada. A program evaluation and QI approach will be used to expand and standardize the program.