Efficacy of infliximab for disc herniation-induced sciatica -: One-year follow-up

被引:94
作者
Korhonen, T
Karppinen, J [1 ]
Malmivaara, A
Autio, R
Niinimäki, J
Paimela, L
Kyllönen, E
Lindgren, KA
Tervonen, O
Seitsalo, S
Hurri, H
机构
[1] Oulu Univ Hosp, Dept Phys Med & Rehabil, PL 25, FIN-90029 Oulu, Finland
[2] Finnish Inst Occupat Hlth, Dept Occupat Med, Helsinki, Finland
[3] Orton Orthopaed Hosp, Helsinki, Finland
[4] Finnish Off Hlth Care Technol Assessment, Helsinki, Finland
[5] Oulu Univ Hosp, Dept Diagnost Radiol, Oulu, Finland
关键词
clinical trial; sciatica; intervertebral disc herniation; infliximab; treatment; TNF-alpha;
D O I
10.1097/01.brs.0000141179.58778.6c
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. An open-label trial. Objectives. To test the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha), in disc herniation-induced sciatica. Summary of Background Data. Our recent trial indicated that a single infusion of 3 mg/weight-kg of infliximab produced a rapid curative effect in disc herniation-induced sciatica. Here, we describe the 1-year effect of a 3 mg/kg of infliximab in these 10 patients and our experience with a lower dose of 1 mg/kg of infliximab for the same indication in 2 additional patients. Methods. Patients with severe sciatica were treated with a single infusion of infliximab, 3 mg/weight-kg in 10 patients and 1 mg/kg in 2 patients, intravenously over 2 hours. The outcomes ( leg and back pain on a 100-mm visual scale, Oswestry disability, clinical signs) were assessed at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the infusion. The outcomes with 3 mg/kg of infliximab were compared to 62 patients who received periradicular saline for sciatica in a previous trial. The resorption rate of disc herniations from baseline to 1 year was compared between infliximab and control groups. Results. The response to 1 mg/kg of infliximab for leg pain was good only in 1 of the 2 patients treated, whereas the response to 3 mg/kg of infliximab for leg pain was sustained in most patients over the 1-year follow-up. The 1-year response significantly favored 3 mg/kg of infliximab over periradicular saline in leg pain ( P = 0.005) and disability ( P = 0.003). Neurologic abnormalities normalized more comprehensively in the infliximab group ( P = 0.001). Reduction in disc herniation volume did not differ between the infliximab-treated patients and controls. Conclusions. The results showed that the beneficial effect of a single infusion of 3 mg/kg of infliximab for herniation-induced sciatica is sustained in most patients over a 1-year follow-up period. Furthermore, infliximab does not seem to interfere with the spontaneous resorption of disc herniations.
引用
收藏
页码:2115 / 2119
页数:5
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