Adalimumab in acute sciatica reduces the long-term need for surgery: a 3-year follow-up of a randomised double-blind placebo-controlled trial.

Details

Serval ID
serval:BIB_1127C971AF42
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Adalimumab in acute sciatica reduces the long-term need for surgery: a 3-year follow-up of a randomised double-blind placebo-controlled trial.
Journal
Annals of the Rheumatic Diseases
Author(s)
Genevay S., Finckh A., Zufferey P., Viatte S., Balagué F., Gabay C.
ISSN
1468-2060 (Electronic)
ISSN-L
0003-4967
Publication state
Published
Issued date
2012
Volume
71
Number
4
Pages
560-562
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
INTRODUCTION: Two subcutaneous injections of adalimumab in severe acute sciatica significantly reduced the number of back operations in a short-term randomised controlled clinical trial.
OBJECTIVE: To determine in a 3-year follow-up study whether the short-term benefit of adalimumab in sciatica is sustained over a longer period of time.
METHODS: The primary outcome of this analysis was incident discectomy. Three years after randomisation, information on surgery could be retrieved in 56/61 patients (92%).A multivariate Cox proportional hazard models, adjusted for potential confounders, was used to determine factors predisposing to surgery.
RESULTS: Twenty-three (41%) patients had back surgery within 3 years, 8/29 (28%) in the adalimumab group and 15/27 (56%) in the placebo group, p=0.04. Adalimumab injections reduced the need for back surgery by 61% (HR)=0.39 (95% CI 0.17 to 0.92). In a multivariate model, treatment with a tumour necrosis factor-α antagonist remained the strongest protective factor (HR=0.17, p=0.002). Other significant predictors of surgery were a good correlation between symptoms and MRI findings (HR=11.6, p=0.04), baseline intensity of leg pain (HR=1.3, p=0.06), intensity of back pain (HR=1.4, p=0.03) and duration of sickness leave (HR=1.01 per day, p=0.03).
CONCLUSION: A short course of adalimumab in patients with severe acute sciatica significantly reduces the need for back surgery.
Keywords
Acute Disease, Adult, Anti-Inflammatory Agents/administration & dosage, Anti-Inflammatory Agents/therapeutic use, Antibodies, Monoclonal, Humanized/administration & dosage, Antibodies, Monoclonal, Humanized/therapeutic use, Back Pain/etiology, Diskectomy, Double-Blind Method, Female, Follow-Up Studies, Humans, Injections, Subcutaneous, Kaplan-Meier Estimate, Magnetic Resonance Imaging, Male, Middle Aged, Sciatica/complications, Sciatica/drug therapy, Treatment Outcome, Tumor Necrosis Factor-alpha/antagonists & inhibitors
Pubmed
Web of science
Create date
10/02/2012 13:28
Last modification date
20/08/2019 12:38
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