Researchers: TNF inhibitor shows promise for sciatica, but steroid injections still preferable

In a study published in Annals of Internal Medicine, investigators at Johns Hopkins Medicine found that steroid injections outperformed tumor necrosis factor inhibitor injections, etanercept, for the treatment of sciatica.

“This new treatment shows a lot of promise, but at least in the doses we gave it — the dose known to be safe — steroids still work better,” study investigator Steven P. Cohen, MD, stated in a Johns Hopkins Medicine news release.

Cohen and colleagues performed a blinded, placebo-controlled study of 84 adult patients with sciatica who were provided with two epidural injections of 60 mg steroid, 4 mg etanercept or 2 mL saline. The injections were separated by 2 weeks, the abstract noted. The dose of etanercept administered by the researchers was deemed the optimum safe and effective dose in a pilot study performed by the investigators in patients and animals, according to the release.

Using a primary outcome measure of leg pain 1 month after the second of the two injections, the authors found the patients who received epidural steroids demonstrated greater reductions in the primary outcome measures than patients who received either saline or etanercept.

Patients on steroids reported less pain and less disability than those in the other groups, according to the release.

Seventy-five percent of patients who received epidural steroids reported 50% or greater leg pain relief at 1 month, according to the study results, as compared to 50% in the saline group and 42% in the etanercept group. The authors also noted the steroid group reported lower disability levels (21%) than those in the saline group (29%) or the etanercept group (38%).

The authors added, however, that after the 6-month mark slightly more patients in the saline (40%) and etanercept (38%) groups demonstrated positive outcomes compared to the steroid group (29%).

“The effect of the steroids did not last affirming the fact that steroids work, but not for long,” Cohen stated.

Reference:

Cohen SP, White RL, Kurihara C, et al. Epidural steroids, etanercept, or saline in subacute sciatica: A multicenter, randomized trial. Ann Intern Med. 2012; 156(8):551-559.