• Jian-Rong Guo, Xiao-Ju Jin, Hua-Chun Shen, Huan Wang, Xun Zhou, Xiao-Qian Liu, and Na-Na Zhu.
• 1 Gongli Hospital, the Second Military Medical University, Shanghai, People's Republic of China.
• Ann Pharmacother. 2017 Dec 1; 51 (12): 1041-1052.

BackgroundThere remains a lack of a systematic summary of the efficacy and safety of various medicines for sciatica, and discrepancies among these exist.ObjectiveThe aim of this study is to comprehensively assess the efficacy of and tolerance to several medical options for the treatment of sciatica.MethodsWe performed a network meta-analysis and illustrated the results by the mean difference or odds ratio. The surface under the cumulative ranking curve (SUCRA) was used for indicating the preferable treatments. All data analyses and graphs were achieved via R 3.3.2 and Stata 13.0.ResultsThe subcutaneous anti-tumor necrosis factor-α (anti-TNF-α) was superior to the epidural steroid + anesthetic in reducing lumbar pain in both acute + chronic sciatica patients and acute sciatica patients. The epidural steroid demonstrated a better ability regarding the Oswestry disability score (ODI) compared to the subcutaneous anti-TNF-α. In addition, for total pain relief, the use of nonsteroidal antiinflammatory drugs was inferior to the epidural steroid + anesthetic. The epidural anesthetic and epidural steroid + anesthetic both demonstrated superiority over the epidural steroid and intramuscular steroid. The intravenous anti-TNF-α ranked first in leg pain relief, while the subcutaneous anti-TNF-α ranked first in lumbar pain relief, and the epidural steroid ranked first in the ODI on the basis of SUCRA. In addition, their safety outcome (withdrawal) rankings were all medium to high.ConclusionsIntravenous and subcutaneous anti-TNF-α were identified as the optimal treatments for both acute + chronic sciatica patients and acute sciatica patients. In addition, the epidural steroid was also recommended as a good intervention due to its superiority in reducing ODI.

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