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KMID : 1189320220160010099
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Asian Spine Journal
2022 Volume.16 No. 1 p.99 ~ p.106
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Improvements in Intractable Lumbar and Lower-Extremity Symptoms after Systemic Administration of Tocilizumab, an Anti-interleukin-6 Receptor Antibody
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Sainoh Takeshi
Orita Sumihisa
Miyagi Masayuki
Suzuki-Narita Miyako
Sakuma Yoshihiro
Oikawa Yasuhiro
Kubota Go
Sato Jun
Shiga Yasuhiro
Fujimoto Kazuki
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Abstract
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Study Design: Prospective cohort study (open-label, single-arm, and non-blinded).
Purpose: This study aims to determine the effects of systemic administration of tocilizumab, an anti-interleukin-6 (IL-6) receptor antibody on refractory low back pain and leg symptoms.
Overview of Literature: IL-6 overexpression is associated with neuropathic pain pathogenesis, which is potentially followed by chronic low back pain, including leg pain and numbness. This finding suggest that inhibition of IL-6 at the site of pain or in the transmission pathway could provide novel therapeutic targets for chronic low back pain.
Methods: This prospective, single-arm study included 11 patients (eight men; mean age, 62.7 years) with ≥3-months’ chronic pain history due to lumbar disease. Subcutaneous TCZ injections were administered twice, at a 2-week interval. We evaluated low back pain, leg pain, and leg numbness using numeric rating scales and the Oswestry Disability Index (ODI; baseline and 6 months postinjection); serum IL-6 and tumor necrosis factor-α levels (baseline and 1 month postinjection); and clinical adverse events.
Results: Intractable symptoms reduced after TCZ administration. Low back pain improved for 6 months. Improvements in leg pain and numbness peaked at 4 and 1 month, respectively. Improvements in ODI were significant at 1 month and peaked at 4 months. Serum IL-6 was increased at 1 month. IL-6 responders (i.e., patients with IL-6 increases >10 pg/mL) showed particularly significant improvements in leg pain at 2 weeks, 1 month, and 2 months compared with nonresponders. We observed no apparent adverse events.
Conclusions: Systemic TCZ administration improved symptoms effectively for 6 months, with peak improvements at 1?4 months and no adverse events. Changing serum IL-6 levels correlated with leg pain improvements; further studies are warranted to elucidate the mechanistic connections between lumbar disorders and inflammatory cytokines.
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KEYWORD
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Interleukin-6, Chronic pain, Low back pain, Analgesic, Tocilizumab
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