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

Williams, Nefyn H, Lewis, R, Ud Din, N, Matar, HE, Fitzsimmons, D, Phillips, C, Sutton, A., Burton, A. Kim, Hendry, Maggie, Nafees, S and Wilkinson, Clare (2013) A systematic review and meta-analysis of biological treatments targeting tumour necrosis factorα for sciatica. European Spine Journal, 22 (9). pp. 1921-1935. ISSN 1432-0932

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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.

Item Type:	Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RM Therapeutics. Pharmacology
Schools:	School of Human and Health Sciences School of Human and Health Sciences > Centre for Health and Social Care Research
Related URLs:	Author
Depositing User:	Kim Burton
Date Deposited:	20 Aug 2013 13:00
Last Modified:	30 Nov 2016 17:30
URI:	http://eprints.hud.ac.uk/id/eprint/18158

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