• Nefyn H Williams, Ruth Lewis, Nafees Ud Din, Hosam E Matar, Deborah Fitzsimmons, Ceri J Phillips, Alex Sutton, Kim Burton, Maggie Hendry, Sadia Nafees, and Clare Wilkinson.
• North Wales Centre for Primary Care Research, North Wales Clinical School, Bangor University, Gwenfro 4-8, Wrexham Technology Park, Wrexham, LL13 7YP, UK, nefyn.williams@bangor.ac.uk.
• Eur Spine J. 2013 Sep 1; 22 (9): 1921-35.

PurposeSystematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.MethodsWe searched 21 electronic databases and bibliographies of included studies. We included randomised controlled trials (RCTs), non-RCTs and controlled observational studies of adults who had sciatica treated by biological agents compared with placebo or alternative interventions.ResultsWe pooled the results of six studies (five RCTs and one non-RCT) in meta-analyses. Compared with placebo biological agents had: better global effects in the short-term odds ratio (OR) 2.0 (95 % CI 0.7-6.0), medium-term OR 2.7 (95 % CI 1.0-7.1) and long-term OR 2.3 [95 % CI 0.5 to 9.7); improved leg pain intensity in the short-term weighted mean difference (WMD) -13.6 (95 % CI -26.8 to -0.4), medium-term WMD -7.0 (95 % CI -15.4 to 1.5), but not long-term WMD 0.2 (95 % CI -20.3 to 20.8); improved Oswestry Disability Index (ODI) in the short-term WMD -5.2 (95 % CI -14.1 to 3.7), medium-term WMD -8.2 (95 % CI -14.4 to -2.0), and long-term WMD -5.0 (95 % CI -11.8 to 1.8). There was heterogeneity in the leg pain intensity and ODI results and improvements were no longer statistically significant when studies were restricted to RCTs. There was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects.ConclusionsThere was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.

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