#240 Systematic Review of Biological Treatments for Sciatica
Poster Presented by: E.S. Machado
E.S. Machado (1,2)
M. Bredemeier (3)
F.K. de Oliveira (3)
(1) Hospital Nossa Senhora da Conceição, Center of Pain and Paliative Care, Porto Alegre, Brazil
(2) Univida Clinic, Spine Center Canoas, Canoas, Brazil
(3) Hospital Nossa Senhora da Conceição, Rheumatology, Porto Alegre, Brazil
Introduction: Since Mixter and Barr's description of nerve root mechanical compression by a herniated disc, surgical discectomy became the gold standard treatment to disc related sciatica. However, other factors than mechanical compression, play a role in the sciatica. The immunogenic stimulus of the herniated/sequestered disc, results in inflammatory response and chronic pain. Several animal studies investigating the mechanical and inflammatory role in sciatic pain, concluding that both factors act together: mechanical and chemical. Several cytokines are expressed in the inflammatory response to disc herniation. One of these is Tumor Necrosis Factor Alfa (TNF-A) and play a key role in this response. Based on this potent anti-inflammatory action, anti-TNF agents have been indicated to treat several Rheumatic diseases with satisfactory results. Being sciatic pain caused by inflammatory mechanisms, anti-TNF drugs was investigated as alternative treatment to disc-related sciatica. Experimental disc injury in animal studies demonstrates satisfactory inhibition of the inflammatory reaction using anti-TNF drugs. These results warrant theoretical basis to clinical application of anti TNF drugs in humans.
Methods: A Systematic Review was conducted. Randomized Controlled Trials (RCT) involving different kinds of biological agents were performed in Electronic Databases (Medline, Embase and Cochrane). Data extraction and quality assessment was done by two reviewers. Differences were resolved by consensus, or by a third reviewer if necessary.
Results: We identified nine RCTs, comparing three types of biological agents (etanercept, infliximab and adalimumab) with placebo or corticosteroids. Different routes of administration were used. More recent studies with longer follow-up showed a trend of less surgical indication in patients treated with biologics.
Conclusion: These individual results do not support or recommend the use of anti-TNF in clinical practice yet. Study's analysis confirms the safety of this technique and warrant the continuity of research with larger and homogeneous multicenter, randomized controlled trials.