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

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Abstract

Purpose

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

Methods

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.

Results

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.

Conclusions

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

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. North Wales Centre for Primary Care Research, North Wales Clinical School, Bangor University, Gwenfro 4–8, Wrexham Technology Park, Wrexham, LL13 7YP, UK

    Nefyn H. Williams, Ruth Lewis, Nafees Ud Din, Maggie Hendry, Sadia Nafees & Clare Wilkinson

  2. North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK

    Nefyn H. Williams

  3. Sheffield Teaching Hospitals, Sheffield, UK

    Hosam E. Matar

  4. College of Human and Health Sciences, Swansea University, Swansea, UK

    Deborah Fitzsimmons & Ceri J. Phillips

  5. Department of Health Sciences, University of Leicester, Leicester, UK

    Alex Sutton

  6. Spinal Research Institute, University of Huddersfield, Huddersfield, UK

    Kim Burton

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  1. Nefyn H. Williams
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Correspondence to Nefyn H. Williams.

Electronic supplementary material

Appendix: MEDLINE (OVID)

Appendix: MEDLINE (OVID)

Search strategy MEDLINE (OVID) 1950 to June week 1 2008 searched on 16-06-2008. Search updated on 04-12-2009 and on 01-02-2011

  1. 1.

    Sciatica/

  2. 2.

    (Ischialg$ or sciatic$).ti,ab.

  3. 3.

    ((Lumb$ or sacra$ or spin$) adj5 radicul$).ti,ab.

  4. 4.

    ((Sciatic nerve or lumbar nerve or spinal nerve or sacral nerve) adj5 (irritation or inflammat$ or pain or neuropath$ or dysfunction$ or compressio$ or injur$ or traum$)).ti,ab

  5. 5.

    Intervertebral disk displacement/

  6. 6.

    ((Intervertebral disk or intervertebral disc or lumbar disc or lumbar disk or lumbosacral disc or lumbosacral disk or lumbo-sacral disc or lumbo-sacral disk) adj5 (hernia$ or slip$ or prolapse or degeneration or fusion or sclerosis or rupture or distortion or fracture or displacement)).ti,ab.

  7. 7.

    ((Lumbosacral nerve root or lumbo-sacral nerve root or lumbar nerve root) adj5 (irritat$ or inflammat$ or pain$ or neuropath$ or dysfunction$ or compressio$ or injur$ or traum$)).ti,ab.

  8. 8.

    ((Refer$ or radiat$) adj5 (back or leg or foot)).ti,ab.

  9. 9.

    Or/1-8

  10. 10.

    (Treatment$ or therap$ or manag$ or surg$ or modalit$ or intervention$).ti,ab.

  11. 11.

    Bed rest/

  12. 12.

    (Bed rest$ or activ$ or exercise$ or education$ or instruction$ or advice$).ti,ab.

  13. 13.

    Physical therapy modalities/

  14. 14.

    ((Heat or hot or thermal or infra?red or ultrasound or ultrasonic or short-wave or physio$ or physical or exercise) adj5 (therap$ or treatm$)).ti,ab.

  15. 15.

    Transcutaneous electric nerve stimulation/

  16. 16.

    (Transcutaneous electric nerve stimulation or TENS).ti,ab.

  17. 17.

    Complementary therapies/

  18. 18.

    Exp musculoskeletal manipulations/

  19. 19.

    Exp acupuncture therapy/

  20. 20.

    ((Spina$ or chiropract$ or osteopath$ or physi$ or homeopath$ or acupunctur$ or musculo?skeletal or myofunctional) adj5 (massage or manipulat$ or therap$ or treatment$)).ti,ab.

  21. 21.

    Homeopathy/

  22. 22.

    Homeopathy.ti,ab.

  23. 23.

    Herbal Medicine/

  24. 24.

    Herbal medicine.ti,ab.

  25. 25.

    Orthotic devices/

  26. 26.

    (Braces or slings or splints or corset).ti,ab.

  27. 27.

    Traction/

  28. 28.

    Traction.ti,ab.

  29. 29.

    Drug therapy/

  30. 30.

    Exp analgesics/

  31. 31.

    Anti-Inflammatory agents, non-steroidal/

  32. 32.

    ((Non-steroidal anti-inflammatory or non-steroidal anti-inflammatory or non?narcotic or narcotic or opioid$ or opiate$) adj5 (drug$ or analges$)).ti,ab.

  33. 33.

    (Paracetamol or acetaminophen).ti,ab.

  34. 34.

    (Ibuprofen or aceclofenac or acemetacin or celecoxib or dexketoprofen or diclofenac sodium or etodolac or etoricoxib or fenbufen or fenoprofen or flurbiprofen or indometacin or indomethacin or ketoprofen or mefenamic acid or meloxicam or nabumetone or naproxen or piroxicam or sulindac or tenoxicam or tiaprofenic acid or azapropazone or biarison or acetaminophen or nimesulide or oxyphenbutazone or azapropazone or felbinac or alclofenac or nimesulid or etofenama or loxoprofen or phenylbutazone or valdecoxib or lornoxicam or etoricoxib).ti,ab.

  35. 35.

    (Buprenorphine or butorphanol or codeine or dextromoramide or dextropropoxyphene or dihydromorphine or diphenoxylate or etorphine or fentanyl or heroin or hydrocodone or hydromorphone or levorphanol or meperidine or meptazinol or methadone or methadyl acetate or morphine or nalbuphine or oxycodone or oxymorphone or pentazocine or phenazocine or phenoperidine or pirinitramide or promedol or sufentanil or tilidine or tramadol).ti,ab.

  36. 36.

    Epidural analgesia/

  37. 37.

    Epidural injections/

  38. 38.

    ((Intramuscular or intravenous or peri?neural$ or epidura$ or inject$) adj5 (cortico?steroid$ or steroid$ or ana?lgesic$ or chymopapain)).ti,ab.

  39. 39.

    (Dexamethasone or hydrocortisone or prednisolone or methylprednisolone or prednisone or methylprednisone or triamcinolone).ti,ab.

  40. 40.

    Orthopedic procedures/

  41. 41.

    Intervertebral disk chemolysis/

  42. 42.

    ((Disc or disk) adj5 (chemolysis or chemonucleolysis)).ti,ab.

  43. 43.

    Vertebroplasty/

  44. 44.

    Diskectomy/

  45. 45.

    Neurosurgical procedures/

  46. 46.

    Laminectomy/

  47. 47.

    Rhizotomy/

  48. 48.

    (Discectomy or diskectomy or microdiscectomy or microdiskectomy or rhizotomy or sequestrectomy or vertebroplasty or nucleoplasty or laminectomy).ti,ab.

  49. 49.

    Surgical decompression/

  50. 50.

    Surgical decompression. ti,ab.

  51. 51.

    or/11-50

  52. 52.

    9 and 51

  53. 53.

    Limit 52 to human

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Williams, N.H., Lewis, R., Din, N.U. et al. A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica. Eur Spine J 22, 1921–1935 (2013). https://doi.org/10.1007/s00586-013-2739-z

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  • DOI: https://doi.org/10.1007/s00586-013-2739-z

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