Efficacy of etanercept in the treatment of acute, severe sciatica: a pilot study

Objectives: To explore the efficacy of a tumour necrosis factor alpha (TNFalpha) 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.