title: A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica.
abstract: OBJECTIVE
  Systematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  There was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.
authors.affiliation: 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.
authors.forename: Nefyn H
authors.initials: NH
authors.lastname: Williams
authors.forename: Ruth
authors.initials: R
authors.lastname: Lewis
authors.forename: Nafees Ud
authors.initials: NU
authors.lastname: Din
authors.forename: Hosam E
authors.initials: HE
authors.lastname: Matar
authors.forename: Deborah
authors.initials: D
authors.lastname: Fitzsimmons
authors.forename: Ceri J
authors.initials: CJ
authors.lastname: Phillips
authors.forename: Alex
authors.initials: A
authors.lastname: Sutton
authors.forename: Kim
authors.initials: K
authors.lastname: Burton
authors.forename: Maggie
authors.initials: M
authors.lastname: Hendry
authors.forename: Sadia
authors.initials: S
authors.lastname: Nafees
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012585:Sciatica / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept