Anti-nerve growth factor antibodies for the treatment of low back pain

ABSTRACT

Introduction

The treatment of chronic low back pain (cLBP) often involves multimodal pharmacologic and non-pharmacologic strategies. There remain shortcomings with these tools with regards to both effect size and side effects.

Areas covered

In an effort to better address cLBP, anti-nerve growth factor (NGF) monoclonal antibodies (mAbs) are nearing marketing approval. This class of medications has been primarily evaluated for osteoarthritis, but are being examined at higher doses for use in cLBP. We review the efficacy of this class in treating LBP as well as their potential side effects based on nine phase II or III published clinical trials. Five trials evaluated Tanezumab and four trials evaluated Fasinumab, with seven trials evaluating nonspecific LBP, one evaluating sciatica related cLBP, and one evaluating vertebral fracture related cLBP.

Expert opinion

The results of available clinical trials indicate modest effectiveness with regard to reduction of pain in the low back, and improved functionality, compared to placebo in keeping with the effect size of other pharmacologic treatment modalities. Rapidly progressive osteoarthritis was infrequently reported. However, the continued observation of this serious side effects warrants careful patient selection and balancing the risks and benefits of anti-NGF mAbs in treating cLBP.

KEYWORDS:

• Chronic pain
• low back pain
• monoclonal antibodies
• nerve growth factors
• tanezumab
• fasinumab

Article highlights

• The need for novel treatments for many forms of chronic pain has led to the development of anti-NGF mAbs for pain related to osteoarthritis in multiple joints, including the lower back. Their development was guided by preclinical data suggesting NGF’s central role in chronic pain development and maintenance.

• Clinical evaluation of anti-NGF mAbs in the setting of nonspecific low back pain suggest that they are effective at reducing pain and increasing physical function.

• During clinical trials of spine pain, minor and self-resolving side effects were noted with this class of medications, such as neuropathy.

• More significant side effects, such as the development of rapidly progressive osteoarthritis, were noted in studies evaluating the medications for the treatment of hip and/or knee arthritic pain, and generally at lower doses than were evaluated for the treatment of spine pain.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed consultancy for Pfizer and Lilly. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.