Adalimumab for the Treatment of Refractory Sciatica Induced by Disc Prolapse

Abstract

Ten patients with back pain and sciatica were selected according to certain inclusion criteria for a study to assess the efficacy of the Anti TNF agent Adalimumab in the treatment of refractory sciatica pain induced by a lumbar disc prolapse in patients who failed to improve following lumbar epidural steroid or disc surgery. Each was given a subcutaneous injection of 40mg Adalimumab repeated after two weeks. Patients were assessed regularly on weeks 0, 2, 4 and 8 employing the Visual Analogue Score (VAS) for leg pain and back pain and the Straight Leg Raising (SLR) test. The median improvement of the leg pain VAS was 55. Median improvements of back pain VAS was 37. Median improvement of the SLR was 45. The study demonstrated the beneficial effect of adalimumab therapy in reducing the back and leg pain associated with sciatica in this difficult to treat group of patients. The improvement of leg pain was more significant than that of back pain. The response was better in patients with symptoms of shorter duration and with less SLR restriction at base line.