title: Efficacy and tolerance of systemic steroids in sciatica: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The efficacy of pharmacological interventions in sciatica is limited and the use of systemic steroids is still controversial. We aimed at evaluating the efficacy and tolerance of systemic steroids in sciatica.
  
  
  METHODS
  A systematic literature search was performed in the Medline, Embase and Cochrane databases until February 2010. Randomized placebo-controlled trials evaluating the efficacy and the tolerance of systemic steroids in sciatica were included. Efficacy and tolerance were assessed using the relative risk (RR) and 95% CI with the inverse variance method (RR > 1 means that the event is more likely to occur in the steroid group). We explored the heterogeneity between the studies using subgroup analysis.
  
  
  RESULTS
  Seven studies (383 patients) were included. The difference in the rate of responders between both groups was not statistically significant (RR = 1.22, 95% CI 0.96, 1.56). The rate of adverse events was 13.3% for the patients in the steroid group and 6.6% for the placebo group (RR = 2.01, 95% CI 1.06, 3.80). The number needed to harm was 20 (95% CI 10, ∞). Twenty (15.3%) patients in the steroid group and seven (5.7%) patients in the placebo group underwent surgery. A trend towards a higher requirement for spinal surgery was observed in the steroid group (RR = 1.14, 95% CI 0.74, 1.75). The methodological quality slightly influenced the results. We did not find any publication bias.
  
  
  CONCLUSIONS
  Steroid efficacy is not superior to the placebo in sciatica, but it has more side effects. The tolerance : efficacy ratio indicates against the use of systemic steroids in sciatica.
authors.affiliation: Emergency Department, CHU A Michallon, Grenoble, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Roncoroni
authors.forename: Athan
authors.initials: A
authors.lastname: Baillet
authors.forename: Marjorie
authors.initials: M
authors.lastname: Durand
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Robert
authors.initials: R
authors.lastname: Juvin
mesh_terms: D000328:Adult; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010919:Placebos / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012585:Sciatica / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D010919:Placebos; D003907:Dexamethasone; D011239:Prednisolone; D008775:Methylprednisolone