Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation

ABSTRACT Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.

A study of the efficacy of liposomes in comparison to new and established adjuvants in potentiating the antibody response against hepatitis B virus surface antigen.

The dehydration-rehydration vesicle (DRV) method was used to encapsulate hepatitis B surface antigen (HBsAg) in phosphatidylcholine (PC) and distearoyl phosphatidylcholine (DSPC) liposomes giving entrapment values of 31.7% and 33.1% respectively. A comparison of antibody levels, as determined by ELISA, in the primary and secondary immune responses in mice immunized twice with 1 microgram HBsAg free, or in formulations of PC DRV, DSPC DRV, Syntex Adjuvant Formulation (SAF), alum and Freund's Complete Adjuvant (FCA) showed that by far, FCA was the best adjuvant in both the primary and secondary IgG1, IgG2a and IgG2b responses. In the secondary response, apart from FCA, DSPC DRV and SAF were equally efficacious and better adjuvants than alum and PC DRV for the IgG2a and IgG2b subclasses. SAF was a better adjuvant for HBsAg than alum, DSPC DRV and PC DRV (in descending order of efficacy) in the secondary IgG1 response.