RESEARCH - More positive results with a TNF inhibitor in sciatica

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More positive results with a TNF inhibitor in sciatica

Rheumawire

September 16, 2004

Nainggolan

Geneva, Switzerland - A pilot study of the TNF inhibitor etanercept

(Enbrel, Wyeth) in patients with severe sciatica has shown that the drug

appears to be effective, prompting further calls for randomized

controlled trials in this potential new indication [1].

Dr Stephane Genevay (University Hospital of Geneva, Switzerland) and

colleagues report results from 10 patients in the September 2004 issue

of the ls of Rheumatic Diseases and comment: " These results suggest

that inhibition of TNF-alpha is beneficial in the treatment of sciatica

and support a role for TNF-alpha in the pathogenesis of sciatica. "

The report comes on the heels of another positive study, this time with

infliximab (Remicade, Centocor), in which a single infusion of

infliximab produced prompt pain relief in an open-label study of

patients with severe sciatica, as reported by rheumawire last year [2].

Both sets of authors said randomized controlled trials of TNF inhibitors

in sciatica are now needed, a call echoed by Dr

(University of Manchester Rheumatic Diseases Center, Hope Hospital,

Salford, UK), in an editorial in Rheumatology earlier this year [3].

tells rheumawire that he has since applied for funding to

undertake a randomized controlled trial of TNF blockers in sciatica and

hopes to hear in the near future if the funding will be granted.

Genevay and colleagues gave 10 consecutive patients hospitalized with

severe sciatica 3 injections of etanercept (25 mg sc every 3 days) in

addition to standard analgesia. The control group consisted of 10

patients with severe sciatica who took part in an observational study on

IV methylprednisolone.

Response was evaluated at day 10 and week 6 using a visual analog scale

for leg pain (VASL) and for low back pain (VASB), and 2 validated

functional scores: Oswestry disability index (ODI) and the Roland

disability questionnaire (RMDQ).

In the etanercept group, all variables improved: VASL from 74 to 12;

VASB from 36 to 7; ODI from 75.4 to 17.3; and RMDQ from 17.8 to 5.8; all

p<0.001. Pain (VASL and VASB: p<0.001) and ODI (p<0.05) were

significantly better in the etanercept group than in the

methylprednisolone group.

" Patients with severe sciatica had sustained improvement after

short-term treatment with etanercept that was better than standard care

plus a short course of methylprednisolone, " the researchers say.

However, they warn, " these results should not be generalized. " The group

studied was a highly selected group with severe sciatica requiring

admission to the hospital, and the benefit of this treatment may not be

as significant when treating less severe symptoms, they note.

" Only randomized controlled trials will provide a definitive answer

about the role of TNF-alpha in the pathogenesis of sciatica and the

potential of TNF inhibitors for its treatment, " they add. Also, " further

studies should explore the cost-effectiveness of TNF inhibitors in

severe sciatica, " they conclude.

Sources

Genevay S, Stingelin S, and Gabay C. Efficacy of

etanercept in the treatment of acute, severe sciatica: a pilot study.

Ann Rheum Dis 2004; 63:1120-1123.

Karppinen J, Korhonen T, Malmivaara A, et al. Tumor

necrosis factor-alpha monoclonal antibody, infliximab, used to manage

severe sciatica. Spine 2003; 28:750-3.

RG, Freemont AJ. TNF-alpha blockade for

herniated intervertebral disc-induced sciatica: a way forward at last? .

Rheumatology 2004; 43:119-121.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org