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

ABSTRACT:

Purpose

Systematic review comparing biological agents, targeting tumour necrosis factor ?, 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.

SUBMITTER: Williams NH

PROVIDER: S-EPMC3777072 | biostudies-literature | 2013 Sep

REPOSITORIES: biostudies-literature

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Publications

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

Williams Nefyn H NH Lewis Ruth R Din Nafees Ud NU Matar Hosam E HE Fitzsimmons Deborah D Phillips Ceri J CJ Sutton Alex A Burton Kim K Hendry Maggie M Nafees Sadia S Wilkinson Clare C

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 20130326 9

<h4>Purpose</h4>Systematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.<h4>Methods</h4>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.<h4>Results</h4>We pooled the results of six studie ...[more]

PMID: 23529742

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