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BackCare Medal 2003
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Inflizimab for Severe Sciatica fractures |
At the 2003 AGM of the Society for Back Pain Research, held in London, the award - a
paperweight and certificate - was presented to Mr Karppinen and colleagues
for their paper.
J. Karppinen, T. Horhonen, A. Malmivaara, L. Paimela, S. Seitsalo, K-A Lindgren, P Ranatanen and H. Hurri
Finnish Institute of Occupational Health and Orton Hospital Invalid Foundation, Helsinki and Department of
Physical Medicine and Rehabilitation, Oulu University Hospital, Oulu, Finland.
Introduction:
Infliximab, a monoclonal antibody against tumour necrosis factor alfa (TNF) has been used successfully in the
treatment of rheumatoid arthritis and Crohn's disease. Recent animal studies suggest that TNF also has an
important role in the pathogenesis of sciatica. The purpose of this study was to evaluate the efficacy and
safety of infliximab in the treatment of sciatic patients.
Methods:
10 patients with acute or subacute severe sciatica (duration of symptoms from 2 to 12 weeks were included).
A disc herniation corresponding to symptoms was confirmed by MRI in each case.
Patients with previous back operation or with contra-indications from infliximab were excluded.
A dose of 3 mg/kg body weight of infliximab in saline was infused intravenously over 2 hours.
Leg pain (100-mm Visual Analog Scale) was recorded before and one hour after the infusion and later at 1 week,
2 weeks, 1 month, 3 months and 6 months.
Changes in leg pain were compared statistically with 62 historial controls (saline group in a study of
periradicular infiltration) using repeated measures analysis of variance. Changes in back pain, back-related
disability on Oswestry Inde and clinical status were also assessed.
Results:
Mean (SD) leg pain before the infusion was 80(18) mm in the infliximab group. One hour after the infusion
there was a degrease of 49% in leg pain. At 1 week mean leg pain was 26(21), at 2 weeks 19(20), at 1 month
18(19), at 3 months 10(16) and a 6 months 13(8). When compared with the historial controls, the difference
was in favour of infliximab for leg pain (19 mm; 95% C1, 6 to 32. P=0.05) and for back-related disability
on Oswestry (12%; 95%C1, 4 to20, P=0.03) over the 6 month follow-up period. At the one-month follow-up every
patient in the infliximab group had returned to work compared to 38% of control patients (P=0.02). None of
the patients treated with inflixmab underwent surgery during the follow-up compared to 14(23%) in the control
group (P=0.09). No immediate or delayed adverse drug reactions were observed.
Conclusions:
According to this study, a single infusion of infliximab seems to provide immediate, highly effective and
safe treatment of sciatica through 6 months. Rapid return to work appears to be fascilitated and surgery may
possibily be avoided in some patients. There is an urgent need for a randomized trial to verify these
results.
Back
Care Medal 2002
Back
Care Medal 2001
Back
Care Medal 2000
BackCare
Medal 1999
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