European Spine Journal

, Volume 22, Issue 9, pp 1921–1935 | Cite as

A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

  • Nefyn H. Williams
  • Ruth Lewis
  • Nafees Ud Din
  • Hosam E. Matar
  • Deborah Fitzsimmons
  • Ceri J. Phillips
  • Alex Sutton
  • Kim Burton
  • Maggie Hendry
  • Sadia Nafees
  • Clare Wilkinson
Review Article



Systematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.


We searched 21 electronic databases and bibliographies of included studies. We included randomised controlled trials (RCTs), non-RCTs and controlled observational studies of adults who had sciatica treated by biological agents compared with placebo or alternative interventions.


We pooled the results of six studies (five RCTs and one non-RCT) in meta-analyses. Compared with placebo biological agents had: better global effects in the short-term odds ratio (OR) 2.0 (95 % CI 0.7–6.0), medium-term OR 2.7 (95 % CI 1.0–7.1) and long-term OR 2.3 [95 % CI 0.5 to 9.7); improved leg pain intensity in the short-term weighted mean difference (WMD) −13.6 (95 % CI −26.8 to −0.4), medium-term WMD −7.0 (95 % CI −15.4 to 1.5), but not long-term WMD 0.2 (95 % CI −20.3 to 20.8); improved Oswestry Disability Index (ODI) in the short-term WMD −5.2 (95 % CI −14.1 to 3.7), medium-term WMD −8.2 (95 % CI −14.4 to −2.0), and long-term WMD −5.0 (95 % CI −11.8 to 1.8). There was heterogeneity in the leg pain intensity and ODI results and improvements were no longer statistically significant when studies were restricted to RCTs. There was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects.


There was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.


Sciatica Systematic review Meta-analysis Biological agents Tumour necrosis factor α 



We would like to thank Tosan Okoro, Philip Sell and colleagues who provided additional data from their trial. This review used updated searches from a larger review which was funded by the UK NIHR Health Technology Assessment Programme (project number 06/79/01) and has been published in full in Health Technology Assessment; vol. 15 no. 39. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health.

Conflict of interest

There are no conflicts of interest.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Nefyn H. Williams
    • 1
    • 2
  • Ruth Lewis
    • 1
  • Nafees Ud Din
    • 1
  • Hosam E. Matar
    • 3
  • Deborah Fitzsimmons
    • 4
  • Ceri J. Phillips
    • 4
  • Alex Sutton
    • 5
  • Kim Burton
    • 6
  • Maggie Hendry
    • 1
  • Sadia Nafees
    • 1
  • Clare Wilkinson
    • 1
  1. 1.North Wales Centre for Primary Care Research, North Wales Clinical SchoolBangor UniversityWrexhamUK
  2. 2.North Wales Organisation for Randomised Trials in Health (NWORTH)Bangor UniversityBangorUK
  3. 3.Sheffield Teaching HospitalsSheffieldUK
  4. 4.College of Human and Health SciencesSwansea UniversitySwanseaUK
  5. 5.Department of Health SciencesUniversity of LeicesterLeicesterUK
  6. 6.Spinal Research InstituteUniversity of HuddersfieldHuddersfieldUK

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