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Original Investigation
November 18, 2021

Association Between Pentosan Polysulfate Sodium and Retinal Disorders

Author Affiliations
  • 1Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
  • 2Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham
  • 3Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
JAMA Ophthalmol. Published online November 18, 2021. doi:10.1001/jamaophthalmol.2021.4778
Key Points

Question  Is pentosan polysulfate sodium (PPS) use associated with maculopathy?

Findings  In this disproportionality analysis, users of PPS were proportionately more likely to report adverse events associated with retinal disorder compared with users of other drugs for interstitial cystitis and bladder pain.

Meaning  These findings add to the growing evidence that PPS is associated with certain retinal disorders.


Importance  Case series have identified a macular condition hypothesized to be associated with the use of pentosan polysulfate sodium (PPS). Observational studies seeking to quantify this association have yielded equivocal results.

Objective  To estimate the association between PPS exposure and maculopathy.

Design, Setting, and Participants  This disproportionality analysis was conducted using the US Food and Drug Administration Adverse Event Reporting System from January 2013 through June 2020.

Exposure  Adverse event reports for pentosan polysulfate were selected and compared with adverse event reports associated with drugs taken for the following indications: interstitial cystitis, cystitis, bladder disorder, or bladder pain.

Main Outcome Measures  Retinal adverse events were identified using the retinal disorders Standardized Medical Dictionary for Regulatory Activities (MedDRA) Query, which includes conditions associated with retinal damage attributable to blockage of its blood supply, nutritional deficiencies, toxins, and diseases affecting the retina.

Results  There were 2775 reports available for analysis in the PPS group (of which 1966 were for women [70.9%]) and 6833 reports in the other drugs group (of which 4036 [59.1%] were for women). The proportion of adverse events for any macular event relative to all other events was elevated for the users of PPS compared with those using other interstitial cystitis and bladder pain drugs (proportionate reporting ratio [PRR], 1.21 [95% CI, 1.01-1.44]). With respect to specific retinal conditions, macular degeneration (20 [0.8%] vs 15 [0.2%]), maculopathy (83 [3.4%] vs 2 [0.03%]), retinal dystrophy (3 [0.1%] vs 0), retinal injury (5 [0.2%] vs 0), and retinal toxicity (3 [0.1%] vs 0) were proportionately more common among users of PPS compared with those using other interstitial cystitis and bladder pain drugs, respectively.

Conclusions and Relevance  The results of the current study add to the growing evidence that PPS use is associated with an increased risk of maculopathy. Studies that rule out prevalent retinal abnormalities prior to the initiation of PPS would strengthen the current body of literature.

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