The effect of infliximab, a monoclonal antibody against TNF-alpha, on disc herniation resorption: a randomized controlled study.
METHODS
Randomized, controlled study.


OBJECTIVE
To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption.


BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Infliximab did not appear to interfere with disc herniation resorption over a 6-month period.
Autio
Reijo A
RA
Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. reijo.autio@mhso.fi
Karppinen
Jaro
J
Niinimäki
Jaakko
J
Ojala
Risto
R
Veeger
Nic
N
Korhonen
Timo
T
Hurri
Heikki
H
Tervonen
Osmo
O
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D001862:Bone Resorption / Q000503:physiopathology*; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D007403:Intervertebral Disc / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D013126:Spinal Nerve Roots / Q000187:drug effects; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab