A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica
- 582 Downloads
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.
KeywordsSciatica 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.
- 6.Bush K, Cowan N, Katz DE, Gishen P (1992) The natural history of sciatica associated with disc pathology; a prospective study with clinical and independent radiological follow-up. Spine 18:1433–1438Google Scholar
- 10.The NHS Information Centre, Hospital Episode Statistics for England, Inpatient statistics, Total procedures and interventions 2010–11. http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=210. Accessed 23 August 2012
- 12.Lewis R, Williams NH, Matar HE, Din N, Fitzsimmons D, Phillips C, Jones M, Sutton A, Burton K, Nafees S, Hendry M, Rickard I, Chakraverty R, Wilkinson C (2011) The clinical effectiveness and cost effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 15(39):353–467Google Scholar
- 15.Effective Public Health Practice Project (2010) Quality assessment tool for quantitative studies. http://www.ephpp.ca/PDF/Quality%20Assessment%20Tool_2010_2.pdf. Accessed 23 August 2012
- 20.Cohen SP, Bogduk N, Dragovich A, Buckemaier CC III, Griffith S, Kurihara C, Raymond JL, Richter PJ, Williams N, Yaksh TL (2009) Randomized, double-blind, placebo-controlled, dose-response and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Anesthesiology 110:1116–1126PubMedCrossRefGoogle Scholar
- 23.Korhonen T, Karppinen J, Paimela L, Malmivaara A, Lindgren K-A, Jarvinen S, Niirimaki J, Veeger N, Seitsalo S, Hurri H (2005) The treatment of disc herniation induced sciatica with infliximab; results of a randomized, controlled 3 month follow-up study. Spine 30:2724–2728PubMedCrossRefGoogle Scholar
- 24.Korhonen T, Karppinen J, Paimela L, Malmivaara A, Lindgren K-A, Bowman C, Hammond A, Kirkham B, Jarvinen S, Niirimaki J, Veeger N, Haapea M, Torkki M, Tervonen O, Seitsalo S, Hurri H (2006) The treatment of disc herniation induced sciatica with infliximab; one year follow-up results of FIRST II, a randomised controlled trial. Spine 31:2759–2766PubMedCrossRefGoogle Scholar
- 32.Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7(27):1–91Google Scholar
- 36.Milligan ED, Sloane EM, Langer SJ, Hughes TS, Jekich BM, Frank MG, Mahoney JH, Levkoff LH, Maier SF, Cruz PE, Flotte TR, Johnson KW, Mahoney MM, Chavez RA, Leinwand LA, Watkins LR (2006) Repeated intrathecal injections of plasmid DNA encoding interleukin-10 produce prolonged reversal of neuropathic pain. Pain 126(1–3):294–308PubMedCrossRefGoogle Scholar