Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis

Abstract

Key Points Question Are medicinal cannabinoids effective and well tolerated in the treatment of multiple sclerosis? Findings In this systematic review and meta-analysis of 17 randomized clinical trials including 3161 patients, cannabinoids were significantly associated with efficacy for subjective spasticity, pain, and bladder dysfunction compared with placebo. Cannabinoids had a higher risk of adverse events and withdrawals due to adverse events, with no statistically significant differences found for serious adverse events. Meaning Cannabinoids appear to be safe regarding serious adverse events, but their clinical benefit may be limited.

Clinical uses of cannabis and cannabinoids in the United States

“…Indications range from post-traumatic stress disorder to hepatitis C, and states also differ on the quantity of cannabis that patients may have at a given time [13]. The best evidence exists for the role of cannabis in alleviating pain and spasticity due to MS. A 2018 meta-analysis examined 17 randomized clinical trials (RCTs) of both cannabis in standardized dosages and relative THC:CBD ratios as well as cannabinoid-based medications for this use [31]. Totaling over 3000 patients, aggregate data showed modest, though statistically significant, positive effects on pain, spasticity, and bladder dysfunction.…”

Oral Administration of Cannabis and Δ-9-tetrahydrocannabinol (THC) Preparations: A Systematic Review

“…Several medical products with marketing authorization contain THC as their main component, including dronabinol (synthetic THC), commercialized as oral capsules (Marinol ® ) or as an oral solution (Syndros ® ), and nabilone (a synthetic THC analogue), which is marketed as oral capsules (Cesamet ® or Canemes ® ). Nabiximols (Sativex ® ), available as a buccal spray, also includes CBD in its formulation [ 14 , 24 , 25 , 26 ]. However, few cannabis products have sufficient evidence to obtain approval for therapeutic use in the USA and several European countries.…”

Cannabinoids for Symptoms of Multiple Sclerosis

“…Newer information suggests that higher doses of CBD may in fact be more important in realizing the potential of this category of therapy. 10 Torres-Moreno et al 1 have conducted a methodologically sound meta-analysis; however, this does not overcome the limitation of the relatively weak trials that were included. In light of uncertainty around clinically meaningful benefit and heterogeneity of the studies and results, they appropriately avoid drawing strong conclusions regarding the role for cannabinoids in managing symptoms of MS.…”