Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 28; no. 8; pp. 750 - 753
• Main Authors: Karppinen, Jaro, Korhonen, Timo, Malmivaara, Antti, Paimela, Leena, Kyllönen, Eero, Lindgren, Karl-August, Rantanen, Pekka, Tervonen, Osmo, Niinimäki, Jaakko, Seitsalo, Seppo, Hurri, Heikki
• Format: Journal Article
• Language: English
• Published: United States 15-04-2003
• Subjects: Adult; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Female; Follow-Up Studies; Humans; Infliximab; Infusions, Intravenous; Intervertebral Disc Displacement - complications; Male; Middle Aged; Sciatica - drug therapy; Sciatica - etiology; Sciatica - immunology; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - immunology
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.BRS.0000058944.38900.CE

An open-label study was conducted.
To evaluate the efficacy and safety of infliximab, a monoclonal chimeric antibody, against tumor necrosis factor-alpha (TNFalpha) for the treatment of severe sciatica.
Evidence from animal studies indicates that TNFalpha plays a role in the pathophysiology of sciatica. Anti-TNFalpha therapy has not been previously evaluated in sciatic patients.
In this study, 10 patients with disc herniation-induced severe sciatica received infliximab (Remicade 3 mg/kg) intravenously over 2 hours. The outcome was assessed at 1 hour, 1 week, 2 weeks, 1 month, and 3 months after the infusion and compared to historical control subjects consisting of 62 patients who received saline in a trial of periradicular infiltration for sciatica. Leg pain was the primary outcome, with more than a 75% decrease from the baseline score constituting a painless state. Fisher's exact test and repeated measures analysis of variance were used for statistical analysis.
At 1 hour after the infusion, leg pain had decreased by 50%. At 2 weeks, 60% of the patients in the infliximab group were painless, as compared with 16% of the control patients (P = 0.006). The difference was sustained at 3 months (90% vs 46%; P = 0.014). Infliximab was superior over the whole follow-up period in terms of leg pain (P = 0.003) and back-related disability (P = 0.004). At 1 month, every patient in the infliximab group had returned to work, whereas 38% of the control subjects still were on sick leave (P = 0.02). None of the patients treated with infliximab underwent surgery during the follow-up period. No immediate or delayed adverse drug reactions and no adverse effects related to medication were observed.
Anti-TNFalpha therapy is a promising treatment option for sciatica. There is an urgent need for a randomized controlled trial to evaluate whether thesepromising early results can be confirmed.