Comparison of tanezumab and non-steroidal anti-inflammatory drugs in efficacy and safety for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Chronic low back pain (CLBP) poses a significant global health burden often managed with non-steroidal anti-inflammatory drugs (NSAIDs). Tanezumab, a nerve growth factor (NGF) inhibitor, presents a potential alternative, but its comparative efficacy and safety relative to NSAIDs remain uncertain. This study aimed to compare tanezumab and NSAIDs for CLBP.

METHODS

This is a systematic review with meta-analysis, following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines and Cochrane Handbook. PubMed, Excerpta Medica Database (EMBASE), the Cochrane Library, and Web of Science were searched for literature published before March 10, 2025. Outcome measures included low back pain intensity (LBPI), Roland-Morris Disability Questionnaire (RMDQ) scores, adverse events (AEs), and response rates. Manager V.5.3.3 was used for statistical assessments.

RESULTS

Three randomized controlled trials (RCTs) were included, comprising 835 participants. Tanezumab at 10 mg dose demonstrated significantly greater reduction in LBPI scores at 1-week, 4-week, 8-week, and 12-week follow-ups compared to NSAIDs. Improvement in RMDQ scores was also superior with 10 mg tanezumab at 2-week and 16-week follow-ups. The 5 mg dose, however, did not exhibit a significant difference in functional improvement compared to NSAIDs. Both the 5 mg and 10 mg tanezumab doses showed similar rates of AEs compared to NSAIDs, except for a higher incidence of abnormal peripheral sensation with 10 mg tanezumab. Response rates ≥ 50% were significantly higher with 10 mg tanezumab compared to NSAIDs.

CONCLUSION

Tanezumab at 10 mg demonstrates better pain relief and functional improvement for CLBP compared to NSAIDs, though it increases the risk of mild peripheral sensation abnormalities. The 5 mg dose, shows a comparable safety profile but no significant therapeutic advantages. While joint safety events significantly impacted development of tanezumab for OA, their rare occurrence in peripheral joints with pre-existing OA and absence in the lumbar spine within CLBP trials suggests its risk-benefit profile appears more acceptable in CLBP than in OA.