Targeting Neurotrophic Factors for Low Back Pain and Sciatica: A Systematic Review and Meta-analysis.
OBJECTIVES
This meta-analysis aims to investigate the efficacy and safety of medicines that target neurotrophic factors for low back pain (LBP) or sciatica.


METHODS
We searched published and trial registry reports of randomised controlled trials evaluating the effect of medicines that target neurotrophic factors to LBP or sciatica in seven databases from inception to December 2020. Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty in the evidence.


RESULTS
Nine studies (3349 participants) were included in the meta-analyses. Low certainty evidence showed that anti-NGF may reduce pain at four weeks (MD -6.63, 95% CI -8.51 to -4.76), and 12 weeks (MD -6.10, -8.34 to -3.87), and may increase adverse effects for chronic LBP (OR 1.16, 0.99-1.36). Higher doses of anti-NGF may offer a clinically important reduction in pain at the cost of increased adverse effects for chronic LBP. Very low certainty evidence showed that anti-NGF and glial cell line-derived neurotrophic factor (pro-GDNF) may not reduce pain for sciatica at four weeks (MD -1.40, -8.26-5.46), at 12 weeks (MD -2.91, -13.69-7.67), and may increase adverse effects for sciatica (OR 3.27, 1.78-6.00).


CONCLUSION
Anti-NGF may offer small reductions in pain intensity for chronic LBP. The effect may depend on the dose and types of medicines. For sciatica, anti-NGF or pro-GDNF may not reduce pain. Medicines that target neurotrophic factors for LBP or sciatica are associated with different adverse effects from commonly prescribed medicines for these conditions.
['Rizzo|Rodrigo R N|RRN|', 'Ferraro|Michael C|MC|', 'Wewege|Michael A|MA|', 'Cashin|Aidan G|AG|', 'Leake|Hayley B|HB|', "O'Hagan|Edel T|ET|", 'Jones|Matthew D|MD|', 'Gustin|Sylvia M|SM|', 'McLachlan|Andrew J|AJ|', 'Day|Richard|R|', 'McAuley|James H|JH|']
Back Pain Meta-Analysis Analgesics Drug Therapy Monoclonal Antibodies Nerve Growth Factor Review