Interventions for treating people with symptoms of bladder pain syndrome: a network meta-analysis

Imamura M, Scott NW, Wallace SA, Ogah JA, Ford AA, Dubos YA, Brazzelli M · The Cochrane Database of Systematic Reviews

The independent counterweight to the sponsor-supported pooling: PPS showed no evidence of improved cure or improvement (odds ratio 1.14, 95% credible interval 0.40 to 3.35, as the summary-of-findings table gives it; the abstract misprints the estimate as 0.14) and no reduction in pain (mean difference 0.42, 95% CrI −1.04 to 1.91), frequency or nocturia, all at low or very low certainty. Antidepressants and neuromuscular blockade were the two categories that separated from control on cure or improvement, and neither on pain.

Population

81 randomized trials, 4,674 people with bladder pain syndrome, 65 active treatments grouped into 31 categories

Intervention

All interventions for bladder pain syndrome, including oral PPS

Comparator

Control, within a Bayesian network

Limitations

Certainty was low or very low throughout because the underlying trials are small and heterogeneous (median 38 participants), so this is an absence of demonstrated benefit rather than a demonstration of absent benefit; six PPS trials fed the network (Bade 1997, Davis 2008, Mulholland 1990, Nickel 2015, Sairanen 2005, Sant 2003); UK NIHR-funded, no author conflicts declared.