The effect of infliximab, a monoclonal antibody against TNF-α, on disc herniation resorption : A randomized controlled study

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 31; no. 23; pp. 2641 - 2645
• Main Authors: AUTIO, Reijo A, KARPPINEN, Jaro, NIINIMÄKI, Jaakko, OJALA, Risto, VEEGER, Nic, KORHONEN, Timo, HURRI, Heikki, TERVONEN, Osmo
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Lippincott 01-11-2006; Hagerstown, MD
• Subjects: Adult; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Bone Resorption - physiopathology; Cerebrospinal fluid. Meninges. Spinal cord; Diseases of the osteoarticular system; Diseases of the spine; Edema - diagnosis; Edema - etiology; Female; Follow-Up Studies; Humans; Infliximab; Infusions, Intravenous; Intervertebral Disc - drug effects; Intervertebral Disc - pathology; Intervertebral Disc - physiopathology; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - diagnosis; Intervertebral Disc Displacement - drug therapy; Intervertebral Disc Displacement - physiopathology; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system (semeiology, syndromes); Neurology; Peripheral Nervous System Diseases - diagnosis; Peripheral Nervous System Diseases - etiology; Spinal Nerve Roots - drug effects; Tumor Necrosis Factor-alpha - immunology; Nervous system diseases; magnetic resonance imaging; Vertebral canal; Cytokine; Resorption; with disc herniation resorption over a o-montn period. infliximab; Monoclonal antibody; Nuclear magnetic resonance imaging; disc herniation resorption; Pain; Infliximab; Tumor necrosis factor; Central nervous system disease; Peripheral nerve disease; Spinal cord disease; Tumor necrosis factor α; Sciatica
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.brs.0000244616.64962.9e

Randomized, controlled study.
To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption.
Although the effects of tumor necrosis factor alpha (TNF-alpha) on HNP resorption are not fully understood, TNF-alpha appears to be an essential mediator in HNP resorption.
As part of a substudy of the FIRST II study, magnetic resonance images (MRIs) were obtained from 21 patients who were candidates for discectomy at weeks 0, 2, 12, and 26 after receiving a single infusion of either 5 mg/kg infliximab (11 patients) or placebo (10 patients). The volume (mm3) of HNP, thickness (mm) and extent (%) of rim enhancement, and presence of nerve root edema were assessed.
HNP volume decreased significantly from baseline to 6 months in both treatment groups (P < 0.01), with no difference noted between the infliximab and placebo groups. By week 2, rim enhancement thickness increased significantly in the infliximab group compared with the placebo group (P = 0.003). Two patients in each group required back surgery before the 6-month assessment.
Infliximab did not appear to interfere with disc herniation resorption over a 6-month period.