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

Abstract

Purpose Systematic review comparing biological agents, targeting tumour necrosis factor a, 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), mediumterm 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), mediumterm 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.

Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica

“…21 We identified seven RCTs, one non-RCT and one historical cohort trial. We combined the results of six RCTs [22][23][24][25][26][27] and one non-RCT 28 comparing biological agents with placebo in meta-analyses.…”

“…The pilot built on previous research in this participant group undertaken by team members, 20,21,30,39 which had already provided information on trial administration, the characteristics of sciatica participants and the effects of biological treatments from previous studies. The internal pilot was designed to rehearse the procedures and logistics to be undertaken in the main trial.…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2013

“…The initial studies performed with a small number of patients were rather positive, but with some contradictory differences. The paper by Williams et al [30] is an excellent systematic review of biological treatments targeting tumor necrosis factor for sciatica. Nine studies, RCTs and non-RCTs, were included in the review: seven compared the anti-TNF agent with placebo and two with alternative interventions.…”

Comment on Williams NH, et al.: a systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica (Eur Spine J, 2013;22(9):1921–35)

“…To the Editor, In this system review, Williams et al [1] compared biological agents, targeting tumour necrosis factor a (TNF-a), for sciatica with placebo and alternative interventions. They found that there was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects.…”