title: Clinical significance of tumor necrosis factor-α inhibitors in the treatment of sciatica: a systematic review and meta-analysis.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Yun Fu
authors: YF
authors: Wang
authors: Medical Imaging Center, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Ping You
authors: PY
authors: Chen
authors: Department of Spine Surgery, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Wei
authors: W
authors: Chang
authors: Department of Neurology, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan City, Guangdong Province, China.
authors: Fi Qi
authors: FQ
authors: Zhu
authors: Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Li Li
authors: LL
authors: Xu
authors: Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Song Lin
authors: SL
authors: Wang
authors: Department of Neurology, Xiangyang Center Hospital Affiliated to Hubei University of Arts and Science, Xiangyang City, Hubei Province, China.
authors: Li Ying
authors: LY
authors: Chang
authors: Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Jie
authors: J
authors: Luo
authors: Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors: Guang Jian
authors: GJ
authors: Liu
mesh_terms: D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012585:Sciatica / Q000188:drug therapy* / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha