Cannabinoid Therapeutic Effects in Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

(1) Introduction: Inflammatory Bowel Disease (IBD) patients may benefit from cannabinoid administration supplementary therapy; currently no consensus on its effect has been reached. (2) Methods: a systematic review of RCTs on cannabinoid supplementation therapy in IBD has been conducted; data sources were MEDLINE, Scopus, ClinicalTrials.gov. (3) Results: out of 974 papers found with electronic search, six studies have been included into the systematic review, and five of them, for a grand total of 208 patients, were included into the meta-analysis. (4) Conclusions: cannabinoid supplementation as adjuvant therapy may increase the chances of success for standard therapy of Crohn’s Disease during the induction period; no statement on its potential usage during maintenance period can be derived from retrieved evidence. Its usage in Ulcerative Colitis is not to be recommended. If ever, low-dose treatment may be more effective than higher dosage. Mean CDAI reduction was found stronger in patients treated with cannabinoids (mean CDAI reduction = 36.63, CI 95% 12.27–61.19) than placebo. In future studies, it is advisable to include disease activity levels, as well as patient-level information such as genetic and behavioral patterns.

Therapeutic Effects of Cannabinoids on Ulcerative Colitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…It is possible that cannabinoids do not have much of an effect on disease activity parameters that relate to inflammation. Both Doeve et al and Vinci et al concluded similarly, reporting little to no impact of cannabinoids on remission or inflammatory biomarkers 29,30 . In contrast, recent studies in animal models of intestinal inflammation have shown a reduction in colonic inflammation, with degrading enzymes for endocannabinoids; such as fatty acid amide hydrolase inhibitors and cannabidiol 37,38 .…”

“…Two systematic reviews without pooling of results, and two meta-analyses with high heterogeneity (with both observational and interventional studies) have already been performed to assess the efficacy and safety of cannabinoids in UC [27][28][29][30] . However, results have been conflicting.…”

The long-term effect on surgery-free survival of biological compared to conventional therapy in Crohn’s disease in real world-data: a propensity-score matched study

“…However, currently, there is no strong evidence concerning this valuable objective in the long term [3]. Thus, in this holistic strategy, an integration between conventional therapy, biological therapy, nutritional/supplementation intervention and surgery are the therapeutic tools that must be carefully selected on a case-by-case basis [1], [4]- [7].…”

The long-term effect on surgery-free survival of biological compared to conventional therapy in Crohn’s disease in real world-data: a retrospective study

“…Thus, in this holistic strategy, integration between conventional therapy, biological therapy, nutritional/supplementation intervention and surgery is the therapeutic tool that must be carefully selected on a case-by-case basis [ 1 , 4 – 7 ].…”