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Eric Bernard Desjarlais, Judy E Kim; Pentosan Polysulfate Sodium Maculopathy: A Big Data Study of Patients with Interstitial Cystitis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):168.
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© ARVO (1962-2015); The Authors (2016-present)
Recent studies describe a novel association between pentosan polysulfate sodium (PPS), an oral glycosaminoglycan used for symptomatic control of interstitial cystitis (IC), and pigmentary maculopathy. We used multivariate logistic regression analysis to investigate this relationship in a multicenter cohort of patients with IC.
The TriNetX Research Network was queried for patients from 30 healthcare organizations who had a diagnosis of IC. The primary outcome measure was any one of six retinopathy diagnoses that may have been used clinically to document PPS-related maculopathy. These included non-exudative age-related macular degeneration (AMD), exudative AMD, drusen, hereditary retinal dystrophy, toxic maculopathy, and unspecified macular degeneration. Logistic regression models comparing groups with and without PPS exposure were fitted, adjusting for covariates including demographics, systemic comorbidities, and exposure to hydroxychloroquine (HCQ), another drug that can cause maculopathy.
There were 18,154 patients in the study, including 1,437 men and 16,717 women with IC. Average age was 54.2 (17.1 SD) years. A total of 4,147 (22.8%) patients had at least one order for PPS. Average duration of PPS therapy was 1.37 (2.37 SD, range 0.00 to 14.33) years. In multivariate logistic regression analysis, there was a statistically significant increase in the odds of retinopathy diagnosis associated with PPS duration (OR = 1.11 per year, 95% CI 1.05 to 1.17, p = 0.0001), HCQ duration (OR = 1.20, 95% CI 1.11 to 1.29, p < 0.0001), age (OR = 1.08, 95% CI 1.07 to 1.09, p < 0.0001), history of smoking (OR = 1.46, 95% CI 1.16 to 1.84, p = 0.0011), essential hypertension (OR = 1.75, 95% CI 1.37 to 2.25, p < 0.0001), diabetes mellitus (OR = 1.31, 95% CI 1.03 to 1.65, p = 0.0244), and significant kidney disease (OR = 1.41, 95% CI 1.11 to 1.77, p = 0.0040). Repeat regression with PPS duration as a categorical variable in two-year increments revealed a significant association starting at 5 to 6 years of PPS therapy (OR = 2.23, 95% CI 1.14 to 3.96, p = 0.0109).
After adjusting for covariates known to increase the risk of retinopathy, there was a statistically significant increase in the odds of retinopathy diagnoses corresponding with duration of PPS therapy. These findings strengthen the body of evidence suggesting an ocular toxicity related to duration of PPS usage.
This is a 2021 ARVO Annual Meeting abstract.
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