The effect of infliximab, a monoclonal antibody against TNF-alpha, on disc herniation resorption - A randomized controlled study

Study Design. Randomized, controlled study.

Objective. To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption.

Summary of Background Data. Although the effects of tumor necrosis factor alpha (TNF-alpha) on HNP resorption are not fully understood, TNF-alpha appears to be an essential mediator in HNP resorption.

Methods. As part of a substudy of the FIRST II study, magnetic resonance images ( MRIs) were obtained from 21 patients who were candidates for discectomy at weeks 0, 2, 12, and 26 after receiving a single infusion of either 5 mg/kg infliximab (11 patients) or placebo (10 patients). The volume (mm(3)) of HNP, thickness (mm) and extent (%) of rim enhancement, and presence of nerve root edema were assessed.

Results. HNP volume decreased significantly from baseline to 6 months in both treatment groups (P <0.01), with no difference noted between the infliximab and placebo groups. By week 2, rim enhancement thickness increased significantly in the infliximab group compared with the placebo group (P = 0.003). Two patients in each group required back surgery before the 6-month assessment.

Conclusions. Infliximab did not appear to interfere with disc herniation resorption over a 6-month period.