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

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2004-10, Vol.29 (19), p.2115-2119
• Main Authors: KORHONEN, Timo, KARPPINEN, Jaro, HURRI, Heikki, MALMIVAARA, Antti, AUTIO, Reijo, NIINIMÄKI, Jaakko, PAIMELA, Leena, KYLLÖNEN, Eero, LINDGREN, Karl-August, TERVONEN, Osmo, SEITSALO, Seppo
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Cerebrospinal fluid. Meninges. Spinal cord; Diseases of the osteoarticular system; Diseases of the spine; Drug Administration Schedule; Drug toxicity and drugs side effects treatment; Female; Follow-Up Studies; Humans; Infliximab; Infusions, Intravenous; Intervertebral Disc Displacement - complications; Leg - pathology; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Pain - drug therapy; Pain - etiology; Pharmacology. Drug treatments; Sciatica - drug therapy; Sciatica - etiology; Time; Toxicity: nervous system and muscle; Treatment Outcome; Tumor Necrosis Factor-alpha - immunology
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.brs.0000141179.58778.6c

An open-label trial. To test the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha), in disc herniation-induced sciatica. 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. 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. 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. 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.