The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

Zeling Huang; Bo Xu; Yujiang Liu; Hua Chen; Xuefeng Cai; Long Zhang; Xiaofeng Shen; Yuwei Li

doi:10.3389/fphar.2023.1151998

The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

Front Pharmacol. 2023 Aug 21:14:1151998. doi: 10.3389/fphar.2023.1151998. eCollection 2023.

Authors

Zeling Huang¹, Bo Xu¹, Yujiang Liu¹, Hua Chen¹, Xuefeng Cai¹, Long Zhang¹, Xiaofeng Shen¹, Yuwei Li¹

Affiliation

¹ Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China.

Abstract

Background: Chemonucleolysis is a minimally invasive treatment of lumbar disc herniation (LDH). However, the low specificity of the enzyme and the existence of serious adverse events limit the application of chemonucleolysis. Clinical studies in recent years have shown that Chondroitin sulfate ABC endolyase (condoliase) is a potential therapeutic enzyme for LDH. Aim. A meta-analysis was conducted to determine the efficacy and safety of condoliase in LDH treatment. Methods: We searched Web of Science, Embase, PubMed, and Cochrane Library databases. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. The outcomes were the total effective rate, Oswestry Disability Index (ODI) score change, the proportion of lumbar surgery after condoliase treatment, herniated mass volume change, Pfirrmann grade change, and adverse events. Review Manager 5.3 and Stata 12.0 were used for meta-, sensitivity, and bias analysis. Results: Ten studies were included. A single-arm meta-analysis showed that the total effective rate was 78% [95% confidence interval (CI) 75%-81%], the proportion of surgery was 9% (95% CI 7%-12%), the proportion of Pfirrmann grade change was 43% (95%CI 38%-47%), and the adverse events were 4% (95% CI 2%-6%) after condoliase treatment. The two-arm meta-analysis showed that the ODI score change [standardized mean difference (SMD) -2.46, 95% CI -3.30 to -1.63] and the herniated mass volume change (SMD -16.97, 95% CI -23.92 to -10.03) of the condoliase treatment group were greater than those of the placebo control group, and there was no difference in adverse events between the two groups (OR 1.52, 95% CI 0.60-3.85). The results of sensitivity and publication bias analyses showed that the results were robust. Conclusion: Condoliase intradiscal injection has excellent eutherapeutic and safety for LDH, thus, has considerable potential as a treatment option besides conservative treatment and surgical intervention for LDH. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022375492, PROSPERO (CRD42022375492).

Keywords: chemonucleolysis; condoliase; lumbar disc herniation; nucleus pulposus; systematic review and meta-analysis.

Publication types

Systematic Review

Grants and funding

This work was supported by the National Natural Science Foundation of China (82174399), Jiangsu Provincial Department of Science and Technology (BK20211084), Jiangsu Provincial Bureau of Traditional Chinese Medicine Program (QN202007); Suzhou Science and Technology Bureau Project (SYS2020183 and SKYXD2022042), Suzhou Research Foundation of Integrated Traditional Chinese and Western Medicine (SKJYD2021227), and the seventh batch of national traditional Chinese medicine experts academic experience inheritance work project [Chinese Medicine Education Letter (2022) No. 76]. We would like to thank Editage (www.editage.com) for English language editing.