Anti-spasticity agents for multiple sclerosis

Shakespeare, David; Boggild, Mike; Young, Carolyn A

doi:10.1002/14651858.cd001332

Cited by 200 publications

(185 citation statements)

References 102 publications

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“…Maximum effects following a single dose of 10 mg oral THC administered on day 1 were noted between 1 and 5 h after drug administration. In contrast to several other trials in SCI and MS patients, which found no or minor effects on objective spasticity measures, 18,20,21,28 there were significant differences between placebo and verum as well as between baseline and treatment values in the SSS.…”

Section: Discussioncontrasting

confidence: 99%

“…[18][19][20][21][22] In contrast to spasticity in MS, that may be of supra-spinal and spinal origin, spasticity in patients with SCI is solely based on spinal lesions. We conducted a double-blind placebo-controlled parallel study (Phase 3) of oral THC (dronabinol, Marinolt) in patients with SCI to investigate its effects on spasticity of spinal origin (Phase 3).…”

Section: Introductionmentioning

confidence: 99%

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The treatment of spasticity with Δ9-tetrahydrocannabinol in persons with spinal cord injury

et al. 2006

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Study design: Open label study to determine drug dose for a randomized double-blind placebocontrolled parallel study. Objectives: To assess the efficacy and side effects of oral D 9 -tetrahydrocannabinol (THC) and rectal THC-hemisuccinate (THC-HS) in SCI patients. Setting: REHAB Basel, Switzerland. Method: Twenty-five patients with SCI were included in this three-phase study with individual dose adjustment, each consisting of 6 weeks. Twenty-two participants received oral THC open label starting with a single dose of 10 mg (Phase 1, completed by 15 patients). Eight subjects received rectal THC-HS (Phase 2, completed by seven patients). In Phase 3, six patients were treated with oral THC and seven with placebo. Major outcome parameters were the spasticity sum score (SSS) using the Modified Ashworth Scale (MAS) and self-ratings of spasticity. Results: Mean daily doses were 31 mg with THC and 43 mg with THC-HS. Mean SSS for THC decreased significantly from 16.72 (77.60) at baseline to 8.92 (77.14) on day 43. Similar improvement was seen with THC-HS. We observed a significant improvement of SSS with active drug (P ¼ 0.001) in the seven subjects who received oral THC in Phase 1 and placebo in Phase 3. Major reasons for drop out were increase of pain and psychological side effects. Conclusion: THC is an effective and safe drug in the treatment of spasticity. At least 15-20 mg per day were needed to achieve a therapeutic effect.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The treatment of spasticity with Δ9-tetrahydrocannabinol in persons with spinal cord injury

et al. 2006

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“…The development of medicinal grade products has allowed high-quality research, particularly in the field of MS. This has led to a higher quality of research when set against, for example, previous studies on medicines for spasticity [52].…”

Section: Resultsmentioning

confidence: 99%

Clinical Use of Cannabinoids for Symptom Control in Multiple Sclerosis

Notcutt

2015

Neurotherapeutics

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The endocannabinoid system was discovered in 1988 but has received little attention for its potential therapeutic possibilities. That has started to change, and since 2000, a significant number of clinical trials of cannabinoids, principally for the control of spasticity in multiple sclerosis, have been undertaken. These studies have been difficult because of the nature of the disease and have involved patients for whom other therapies have failed or proved inadequate. This paper outlines the background to the use of cannabinoids available and discusses the principles of practice associated with their safe use. The focus has been on nabiximols, being the most studied and the only cannabinoid that has been both adequately researched for use in multiple sclerosis and granted a license by the regulators. However, what has emerged is that the effect for many patients can be much wider than just control of spasticity. Within and outside of neurology there seems to be an expanding range of possibilities for the therapeutic use of cannabinoids.

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“…Spasticity, for example, is a common symptom of MS and may affect walking ability. This symptom is usually addressed with oral baclofen or tizanidine [22], although there are no conclusive data of the functional effects of these treatments in patients with MS [23]. More recently, nabiximols has been used as an add-on therapy for those refractory to conventional antispasticity treatment [24].…”

Section: Overview Of the Marketmentioning

confidence: 99%