Study provides new evidence for the efficacy of a TNF inhibitor for relief of persistent sciatica

November 1, 2013: A new randomized study published in the November 1, 2013 issue of the journal Spine (Freeman, B.J., et al., Randomized, Double-blind, Placebo-Controlled, Trial of Transforaminal Epidural Etanercept for the Treatment of Symptomatic Lumbar Disc Herniation. Spine (Phila Pa 1976), 2013. 38(23): p. 1986-94) provides new evidence for the efficacy of a TNF inhibitor for relief of persistent sciatica associated with lumbar disc herniation. Etanercept is a potent anti-inflammatory drug that is a selective blocker of an immune signaling molecule called TNF. Local perilesional methods of administration of etanercept, including epidural injection for treating sciatica associated with lumbar disc herniation were invented by Edward Tobinick M.D. more than a decade earlier (U.S. patent 6,419,944; 6,537,549; and others).

The new Spine study now constitutes the third published favorable clinical trial providing randomized, controlled trial (RCT) data of the efficacy of etanercept for treating sciatica. Dr. Tobinick was the first to publish human data reporting the effectiveness of etanercept for this indication in 2003, with a larger study published in 2004 (Tobinick, E. and S. Davoodifar, Efficacy of etanercept delivered by perispinal administration for chronic back and/or neck disc-related pain: a study of clinical observations in 143 patients. Curr Med Res Opin, 2004. 20(7): p. 1075-85).

Individual results can vary. See the Terms of Use.  Intractable disc-related low back and neck pain are important medical problems with significant unmet medical need.

Four randomized controlled clinical trials support the efficacy of a TNF inhibitor for disc-related pain

November 4, 2013:

U.S. patent 6,419,944 (inventor Edward Tobinick M.D., filed April 5, 2001) contained the first clinical report of rapid improvement in disc-related pain following the administration of perispinal etanercept. Now, more than a decade later, there are four favorable clinical trials that provide randomized, controlled trial (RCT) data supporting the efficacy of etanercept for treating disc-related pain. In 2013, data from two of these RCTs have been presented: the Nov 1 study by Freeman published in Spine; and the study conducted at Chiba University in Japan(Sainoh, T., et al., Intradiscal Administration of Tumor Necrosis Factor-Alpha Inhibitor, Etanercept, Clinically Improves Intractable Discogenic Low Back Pain: A Prospective Randomized Study, in International Society for the Study of the Lumbar Spine 40th Annual Meeting, May 2013). In 2012 the RCT by Ohtori reported positive etanercept data (Ohtori, S., et al., Epidural administration of spinal nerves with the tumor necrosis factor-alpha inhibitor, etanercept, compared with dexamethasone for treatment of sciatica in patients with lumbar spinal stenosis: a prospective randomized study. Spine (Phila Pa 1976), 2012. 37(6): p. 439-44). In 2009 the RCT performed at Walter Reed Army Medical Center provided favorable efficacy and human and animal safety data (Cohen, S.P., et al., Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Anesthesiology, 2009. 110(5): p. 1116-26).


Judgment is entered in favor of plaintiff TACT IP LLC against defendents Janssen Biotech, Inc. and New York University

August 5, 2013:

On August 5, 2013, in the United States District Court for the Eastern District of Virginia, Alexandria Division, judgment in favor of TACT IP, LLC, holding patents of Edward Tobinick, M.D., was entered:

” Case No. 1:12cv909


Upon consideration of the July 19, 2013 Report and Recommendation of the United States Magistrate Judge designated to conduct a hearing in this matter, no objections having been filed, and upon an independent de novo review of the record, it is hereby ORDERED that the Court adopts as its own the findings of fact and recommendation of the United States Magistrate Judge, as set forth in the June 19, 2013 Report and Recommendation.

Accordingly, it is hereby ORDERED that judgment is ENTERED by default in favor of plaintiff TACT IP LLC and against defendants Janssen Biotech, Inc. and New York University…..”

Edward Tobinick’s issued patents, assigned to TACT IP LLC, include, but are not limited to the following U.S. patents: 6419944, 6537549, 6982089, 7214658, 7629311, 8119127, and 8236306. The patents at issue in the entered judgment in favor of TACT IP LLC included those involving epidural administration of etanercept for treatment of symptomatic lumbar disc herniation.

Lead story on 60 Minutes Australia on November 5, 2011 is about the INR

Pleased to announce that the lead story on 60 Minutes Australia on their November 5, 2011 broadcast is their in-depth report about our revolutionary anti-TNF treatment for Alzheimer’s.

The transcript and full-story can be viewed here:

Many thanks to all our patients, friends, and staff that have helped to make this happen and bring this forward.

Validity of the INR’s pioneering work re-confirmed

A newly published randomized study from Chiba University in Japan provides robust scientific support for our pioneering work utilizing novel methods of delivery and indications for etanercept. The new study, published ahead-of-print in the leading journal Spine demonstrated the superiority of epidural administration of etanercept over an epidural steroid injection for treatment of sciatica associated with spinal stenosis. This method of treatment was invented at the INR (U.S. patent 6419944, issued to Edward Tobinick M.D.) a decade ago. When the INR first published our work with etanercept for sciatica in 2003 and 2004 there were many who were [incorrectly] skeptical. This new study joins a favorable randomized, placebo-controlled study conducted by the U.S. Army in conjunction with Johns Hopkins researchers published in 2009 after their [uncredited] consultation with us several years before. Pleased that the truth has again been confirmed.

Anti-TNF Therapies for Rheumatoid Arthritis Could Reduce Alzheimer’s Risk

In the News: November 7, 2010

Anti-TNF Therapies for Rheumatoid Arthritis Could Reduce Alzheimer’s Risk

Source: American College of Rheumatology (ACR)

Newswise — Anti-TNF therapies commonly used to treat rheumatoid arthritis have been found to potentially reduce the risk of developing Alzheimer’s dementia among people with rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and destruction of the joints. People with RA often experience limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

A complication of chronic inflammation in RA is amyloidosis, caused by excess deposits of amyloid proteins in different organs, which can cause harmful effects to the normal function of many organs. While people with Alzheimer’s disease are found to have local deposits of a type of amyloid protein—beta-amyloid peptide—in the brain, the actual cause of Alzheimer’s remains unclear.

Researchers recently set out to evaluate if there is a relationship between different treatments for RA and the incidence of Alzheimer’s dementia. They reviewed medical and pharmacy claims data of over eight million subjects in the U.S. from a commercial database (Verisk Health). A total of 42,193 people with RA were identified. Each RA subject with newly diagnosed Alzheimer’s dementia was compared to 10 people with RA who did not have Alzheimer’s dementia (called “controls”). As researchers made these comparisons, they ensured they were comparing people of the same age, gender, and with the same use of methotrexate, a medication commonly used for RA. Researchers examined the exposure of these individuals to several drugs used to treat RA including sulfasalazine, prednisone, three anti-TNFs (infliximab, etanercept, and adalimumab) and rituximab.

A total of 165 RA subjects with Alzheimer’s dementia were compared to 1,383 RA controls without Alzheimer’s dementia. Researchers found that those who received anti-TNF treatment had a 55 percent reduction in risk of developing Alzheimer’s dementia. This effect was not seen with other drugs used for treatment of RA, including sulfasalazine, prednisone and rituximab


The researchers concluded that anti-TNF agents used to treat people with RA may be useful in reducing the development of Alzheimer’s dementia, although the mechanisms need further investigation.

“In this study, the incidence of Alzheimer’s disease was found to be lower in patients with rheumatoid arthritis who had been treated with anti-TNF agents,” says Dr. Richard Chou, MD, PhD; assistant professor at Dartmouth Medical School and lead investigator in the study. “Although the cause of Alzheimer’s disease is not known, the results suggest that TNF may play a role in its development.”

TNF-antagonists (also called biologics or anti-TNF therapy) are a class of drugs that have been used since 1998. Overall, they have been given to more than 600,000 people worldwide. These drugs are given to lessen inflammation by interfering with a biologic substance called TNF that cause or worsen inflammation.

Patients should talk to their rheumatologists to determine their best course of treatment.

The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Scientific Meeting is the premier meeting in rheumatology. For more information about the meeting, visit or join the conversation on Twitter by using the official hashtag: #ACR2010.


Editor’s Notes: Richard C. Chou, MD, PhD will present this research during the ACR Annual Scientific Meeting at the Georgia World Congress Center at 2:30 PM on Monday, November 8 in Room A411. Dr. Chou will be available for media questions and briefing at 1:30 PM on Tuesday, November 9 in the on-site press conference room, B 212.

Presentation Number: 640

Tumor Necrosis Factor Inhibition Reduces the Incidence of Alzheimer’s Disease in Rheumatoid Arthritis Patients

Richard C Chou, MD, PhD (Section of Rheumatology, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, NH)

Michael A Kane, MD (Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital and Massachusetts Institute of Technology, Boston, MA)

Sanjay Ghimire, MD (Verisk Health, Waltham, MA)

Shiva Gautam, PhD (Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA)

Body: Objective: To investigate the relationship between different rheumatoid arthritis treatments and Alzheimer’s dementia

Background: A complication of chronic inflammation in rheumatoid arthritis (RA) is the deposition of amyloid proteins, resulting in secondary amyloidosis. Alzheimer’s dementia (AD) is associated with the local deposition of beta-amyloid peptide in the brain, although the pathogenetic mechanisms of AD are unclear. The relationship between RA and AD has not been established.

Design/Methods: We reviewed medical and pharmacy claims data from January 2000 to November 2007 for a commercially insured cohort of 8.5 million adults throughout the US. We derived a subcohort of 42,193 patients with a pre-existing diagnosis of RA. In this subcohort, we conducted a nested case-control study of the incidence of AD. We excluded individuals with psoriatic arthritis, inflammatory bowel disease, previous stroke or previous AD. For each individual with newly diagnosed AD (cases) we matched up to 10 controls who did not have a prior diagnosis of AD and were free of AD during the exposure assessment period. Matching criteria included age, gender, duration of exposure assessment period and methotrexate treatment. We examined exposure to sulfasalazine, prednisone, three anti-tumor necrosis factor (TNF) agents (infliximab, etanercept, adalimumab) and rituximab.

Results: In this nested case-control study, a total of 165 patients with AD (cases) were matched to 1,383 controls without AD. Treatment with anti-TNF agents in RA was associated with lower risk for incident AD [adjusted odds ratio (OR) 0.440; 95% confidence interval (CI) 0.223-0.868; p=0. 0178). The risk of AD was not affected by exposure to sulfasalazine, prednisone or rituximab. The results were similar [adjusted OR 0.448; 95% CI 0.225-0.892; p = 0.0222) after adjustment for covariates, including hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, and coronary artery disease.

Conclusion: In this population of adults with RA, we observed that the risk of AD was reduced by TNF inhibitor therapy, but not by other disease modifying agents used for treatment of RA. Tumor necrosis factor may be an important component in the pathogenesis of AD.

Disclosure: Richard Chou, nothing to disclose; Michael Kane, Verisk Health: Consulting fees; Shiva Gautama, nothing to disclose, Sanjay Ghirmire, Verisk Health: Employment (full or part-time).

Welcome to the INR Blog

Welcome to the INR Blog!

This Blog is still in development. The aim of this blog is to add further scientific information to the content of the INR website as soon as it becomes available. If possible in the future postings and comments from website visitors will be enabled. Thank you for your interest.

Edward Tobinick MD

Recent published research results:

Anti-TNF-alpha reduces amyloid plaques and tau phosphorylation and induces CD11c-positive dendritic-like cell in the APP/PS1 transgenic mouse brains. Shi JQ, Shen W, Chen J, Wang BR, Zhong LL, Zhu YW, Zhu HQ, Zhang QQ, Zhang YD, Xu J. Brain Res. 2010 Oct 21.
Inflammation plays an important role in the pathogenesis of Alzheimer’s disease (AD). Overexpression of tumor necrosis factor-alpha (TNF-alpha) occurs in the AD brain. Recent clinical studies have shown that the anti-TNF-alpha therapy improves cognition function of AD patients rapidly. However, the underlying mechanism remains elusive. The present study investigates the effects of intracerebroventricular injection of the monoclonal TNF-alpha antibody, Infliximab, on the pathological features of AD in the APP/PS1 double transgenic mice. We found that Infliximab administration reduced the levels of TNF-alpha, amyloid plaques and tau phosphorylation as early as three days after daily injection of 150micrograms of Infliximab for three days. The number of CD11c-positive dendritic-like cells and the expression of CD11c were found to be increased concurrently after Infliximab injection. These data suggested that the CD11c-positive dendritic-like cells might contribute to the Infliximab-induced reduction of AD-like pathology. Further, our results support the use of anti-TNF-alpha for the treatment of AD. Continue reading