Efficacy of etanercept in the treatment of acute, severe sciatica: a pilot study
- Division of Rheumatology, University Hospital of Geneva, 26 avenue. Beau-Séjour, 1211 Geneva 14, Switzerland
- Correspondence to:
Dr S Genevay
Division of Rheumatology, University Hospital of Geneva, 26 avenue Beau-Séjour, 1211 Geneva 14, Switzerland;
- Accepted 10 March 2004
- Published Online First 28 April 2004
Objectives: To explore the efficacy of a tumour necrosis factor α (TNFα) inhibitor (etanercept, Enbrel) in patients with severe sciatica.
Methods: A pilot study of etanercept was conducted in patients admitted to hospital for acute severe sciatica. Ten consecutive patients received three subcutaneous injections of etanercept (25 mg every 3 days) in addition to standard analgesia. Response was evaluated at day 10 (T1) and week 6 (T2) using a visual analogue scale for leg pain (VASL) and for low back pain (VASB), and two validated functional scores: the Oswestry disability index (ODI) and the Roland Morris disability questionnaire (RMDQ). The control group consisted of 10 patients with severe sciatica, who took part in an observational study on IV methylprednisolone.
Results: In the etanercept group all variables improved: VASB from 36 to 7; VASL from 74 to 12; RMDQ from 17.8 to 5.8, and ODI from 75.4 to 17.3; all p<0.001. Pain (VASL and VASB: p<0.001) and ODI (p<0.05) were significantly better in the etanercept group than in the methylprednisolone group.
Conclusion: In this open, historical group controlled study, patients with severe sciatica had sustained improvement after a short treatment with etanercept that was better than standard care plus a short course of methylprednisolone. These results suggest that inhibition of TNFα is beneficial in the treatment of sciatica and support a pathological role for TNFα in the pathogenesis of sciatica. These results need to be confirmed by a randomised controlled trial.
- CT, computed tomography
- MRI, magnetic resonance imaging
- NP, nucleus pulposus
- NSAIDs, non-steroidal anti-inflammatory drugs
- ODI, Oswestry Disability Index
- RMDQ, Roland Morris Disability Questionnaire
- TNFα, tumour necrosis factor α
- VASB, visual analogue scale for back pain
- VASL, visual analogue scale for leg pain
Disclosure: Etanercept was provided by Wyeth. None of the authors have received or will receive benefit for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript.