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

Research output: Contribution to journalArticle

22 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.
LanguageEnglish
Pages1921-1935
Number of pages15
JournalEuropean Spine Journal
Volume22
Issue number9
Early online date26 Mar 2013
DOIs
Publication statusPublished - Sep 2013

Fingerprint

Sciatica
Meta-Analysis
Biological Factors
Randomized Controlled Trials
Tumor Necrosis Factor-alpha
Odds Ratio
Placebos
Leg
Pain
Diskectomy
Bibliography
Therapeutics
Observational Studies
Databases
Non-Randomized Controlled Trials

Cite this

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
Williams, Nefyn ; Lewis, Ruth ; Ud Din, Nafees ; Matar, Hosam E. ; Fitzsimmons, Deborah ; Phillips, Ceri J. ; Sutton, Alex ; Burton, Anthony ; Hendry, Maggie ; Nafees, Sadia ; Wilkinson, Clare. / A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica. In: European Spine Journal. 2013 ; Vol. 22, No. 9. pp. 1921-1935.
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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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Williams, N, Lewis, R, Ud Din, N, Matar, HE, Fitzsimmons, D, Phillips, CJ, Sutton, A, Burton, A, Hendry, M, Nafees, S & Wilkinson, C 2013, 'A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica', European Spine Journal, vol. 22, no. 9, pp. 1921-1935. https://doi.org/10.1007/s00586-013-2739-z

A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica. / Williams, Nefyn; Lewis, Ruth; Ud Din, Nafees; Matar, Hosam E.; Fitzsimmons, Deborah; Phillips, Ceri J.; Sutton, Alex; Burton, Anthony; Hendry, Maggie; Nafees, Sadia; Wilkinson, Clare.

In: European Spine Journal, Vol. 22, No. 9, 09.2013, p. 1921-1935.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

AU - Williams, Nefyn

AU - Lewis, Ruth

AU - Ud Din, Nafees

AU - Matar, Hosam E.

AU - Fitzsimmons, Deborah

AU - Phillips, Ceri J.

AU - Sutton, Alex

AU - Burton, Anthony

AU - Hendry, Maggie

AU - Nafees, Sadia

AU - Wilkinson, Clare

PY - 2013/9

Y1 - 2013/9

N2 - 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.

AB - 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.

KW - Sciatica

KW - Systematic review

KW - Meta-analysis

KW - Biological agents

KW - Tumour necrosis factor a

UR - https://link.springer.com/journal/586

U2 - 10.1007/s00586-013-2739-z

DO - 10.1007/s00586-013-2739-z

M3 - Article

VL - 22

SP - 1921

EP - 1935

JO - European Spine Journal

T2 - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 9

ER -