Clinical Significance of Tumor Necrosis Factor-α Inhibitors in the Treatment of Sciatica: A Systematic Review and Meta-Analysis
| Autor: | Fi Qi Zhu, Yun Fu Wang, Ping You Chen, Guang Jian Liu, Jie Luo, Li Ying Chang, Li Li Xu, Wei Chang, Song Lin Wang |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Spinal stenosis medicine.medical_treatment lcsh:Medicine Surgical and Invasive Medical Procedures law.invention Disability Evaluation Sciatica Randomized controlled trial law Internal medicine Discectomy Medicine and Health Sciences medicine Humans Pain Management Clinical significance lcsh:Science Pharmacology Multidisciplinary Tumor Necrosis Factor-alpha Pharmaceutics business.industry lcsh:R medicine.disease Surgery Clinical trial Meta-analysis Relative risk lcsh:Q Female Clinical Medicine medicine.symptom business Follow-Up Studies Research Article |
| Zdroj: | PLoS ONE PLoS ONE, Vol 9, Iss 7, p e103147 (2014) |
| ISSN: | 1932-6203 |
| Popis: | Background and objective Currently, no satisfactory treatment is available for sciatica caused by herniated discs and/or spinal stenosis. The objective of this study is to assess the value of tumor necrosis factor (TNF)-α inhibitors in the treatment of sciatica. Methods Without language restrictions, we searched PubMed, OVID, EMBASE, the Web of Science, the Clinical Trials Registers, the Cochrane Central Register of Controlled Trials and the China Academic Library and Information System. We then performed a systematic review and meta-analysis on the enrolled trials that met the inclusion criteria. Results Nine prospective randomized controlled trials (RCTs) and two before-after controlled trials involving 531 patients met our inclusion criteria and were included in this study. Our systematic assessment and meta-analysis demonstrated that in terms of the natural course of the disease, compared with the control condition, TNF-α inhibitors neither significantly relieved lower back and leg pain (both p > 0.05) nor enhanced the proportion of patients who felt overall satisfaction (global perceived effect (satisfaction)) or were able to return to work (return to work) (combined endpoint; p > 0.05) at the short-term, medium-term and long-term follow-ups. In addition, compared with the control condition, TNF-α inhibitors could reduce the risk ratio (RR) of discectomy or radicular block (combined endpoint; RR = 0.51, 95% CI 0.26 to 1.00, p = 0.049) at medium-term follow-up, but did not decrease RR at the short-term (RR = 0.64, 95% CI 0.17 to 2.40, p = 0.508) and long-term follow-ups (RR = 0.64, 95% CI 0.40 to 1.03, p = 0.065). Conclusion The currently available evidence demonstrated that other than reducing the RR of discectomy or radicular block (combined endpoint) at medium-term follow-up, TNF-α inhibitors showed limited clinical value in the treatment of sciatica caused by herniated discs and/or spinal stenosis. |
| Databáze: | OpenAIRE |
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