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

Nefyn Williams, Ruth Lewis, Nafees Ud Din, Hosam E. Matar, Deborah Fitzsimmons, Ceri J. Phillips, Alex Sutton, Anthony Burton, Maggie Hendry, Sadia Nafees, Clare Wilkinson

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26 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)1921-1935
Number of pages15
JournalEuropean Spine Journal
Volume22
Issue number9
Early online date26 Mar 2013
DOIs
Publication statusPublished - Sep 2013

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    Williams, N., Lewis, R., Ud Din, N., Matar, H. E., Fitzsimmons, D., Phillips, C. J., ... Wilkinson, C. (2013). A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica. European Spine Journal, 22(9), 1921-1935. https://doi.org/10.1007/s00586-013-2739-z