Nabiximols in Chronic Neuropathic Pain: A Meta-Analysis of Randomized Placebo-Controlled Trials

Dykukha, Igor; Maleßa, R.; Essner, Ute; Überall, Michael A.

doi:10.1093/pm/pnab050

Cited by 35 publications

(38 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One of the results of this review is that adding THC/CBD to pre-existing treatment for NP did not show any benefits for these patients [43]. On the other hand, a recent review only on nabiximol (THC/CBD) for NP found that it was superior to placebo, but with a small effect size [49]. This small effect size alone may be the reason why it is not useful in combination.…”

Section: Cannabinoids In Combinationmentioning

confidence: 77%

Combination Therapy for Neuropathic Pain. A Systematic Review

Serrano¹,

Carnaval²,

S³

2021

Preprint

View full text Add to dashboard Cite

Pharmacological treatment is poorly effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in multimodal analgesic approach. We performed a systematic review to assess whether there is more and better-quality evidence available since the last review. We evaluated the efficacy, tolerability and safety of double-blind randomized controlled trials involving only adult participants comparing combination therapy (CT: ≥ 2 drugs) to placebo and/or at least one other comparator with NP indication. The primary outcome was the proportion of participants reporting ≥ 50% pain reduction from baseline. Secondary outcome was the proportion of drop-outs due to treatment-emergent-adverse-events. After removing duplicates, 2323 citations were screened. 164 articles were assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only 5 lasted for at least 12 weeks and only 6 complied with required data for complete analysis, but not for meta-analysis. CT has been adopted for years without robust evidence. Efforts to achieve better quality evidence have not improved over the years. In this regard, guidelines for NP should attempt to make recommendations on CT research, prioritizing which combinations to analyze.

show abstract

Section: Cannabinoids In Combinationmentioning

confidence: 77%

Combination Therapy for Neuropathic Pain. A Systematic Review

Serrano¹,

Carnaval²,

S³

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…One of the results of this review is that adding THC/CBD to a pre-existing treatment for NP did not show any benefits for these patients [43]. On the other hand, a recent review on only nabiximol (THC/CBD) for NP found that it was superior to the placebo but with a small effect size [49]. This small effect size alone may be the reason why it is not useful in combination.…”

Section: Cannabinoids In Combinationmentioning

confidence: 77%

Combination Therapy for Neuropathic Pain: A Review of Recent Evidence

Serrano

Carnaval

Videla

2021

JCM

View full text Add to dashboard Cite

Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new independent review to assess whether more and better-quality evidence has become available since the last systematic review. We evaluated the efficacy, tolerability, and safety of double-blinded randomized controlled trials involving only adult participants and comparing combination therapy (CT: ≥2 drugs) with a placebo and/or at least one other comparator with an NP indication. The primary outcome assessed was the proportion of participants reporting ≥50% pain reductions from baseline. The secondary outcome assessed was the proportion of drop-outs due to treatment-emergent adverse events. After removing duplicates, 2323 citations were screened, with 164 articles assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only five lasted for at least 12 weeks and only six complied with the required data for complete analysis. CT has been adopted for years without robust evidence. Efforts have been made to achieve better-quality evidence, but the quality has not improved over the years. In this regard, guidelines for NP should attempt to make recommendations about CT research, prioritizing which combinations to analyze.

show abstract

“…The meta-analyses of the other authors found statistically significant effects of CbMs and MC with the number needed to benefit between 6 and 14 for pain relief of 30% or more [21][22][23]. Andreae et al [24], Dykukha et al [21] and Fisher et al [25] did not analyse adverse outcomes. The number needed to harm for drop-outs due to adverse events ranged between 12 and 25 in the other reviews [22,23].…”

Section: Outcomes For Treatments With Cannabis-derived Medicationsmentioning

confidence: 99%

“…The most recent literature search (until June 2020) was conducted by Dykukha et al [ 21 ], and the most extensive search was for the Cochrane review of Mücke et al [ 22 ]. Mücke et al [ 22 ] and Petzke et al [ 23 ] required at least 2 weeks of treatment to include studies for quantitative analysis.…”

Section: Systematic Reviews With a Meta-analysis Of Randomized Controlled Trials (Rcts) With Cbms For Chronic Neuropathic Painmentioning

confidence: 99%

“…Andreae et al analysed only RCTs with inhaled MC [ 24 ] and Dykukha et al only studies with nabiximols [ 21 ]. Finnerup et al [ 7 ], Mücke et al [ 22 ] and Petzke et al [ 23 ] analysed only RCTs with CbMs (dronabinol, nabilone, nabiximols) and MC available for clinical use.…”

Section: Systematic Reviews With a Meta-analysis Of Randomized Controlled Trials (Rcts) With Cbms For Chronic Neuropathic Painmentioning

confidence: 99%

See 1 more Smart Citation

Cannabis-Based Medicines and Medical Cannabis for Chronic Neuropathic Pain

et al. 2021

View full text Add to dashboard Cite

Neuropathic pain represents a broad category of pain syndromes that include a wide variety of peripheral and central disorders. The overall prevalence of neuropathic pain in the general population is reported to be between 7 and 10%. Management of neuropathic pain presents an unmet clinical need, with less than 50% of patients achieving substantial pain relief with medications currently recommended such as pregabalin, gabapentin, duloxetine and various tricyclic antidepressants. It has been suggested that cannabis-based medicines (CbMs) and medical cannabis (MC) may be a treatment option for those with chronic neuropathic pain. CbMs/MC are available in different forms: licensed medications or medical products (plant-derived and/or synthetic products such as tetrahydrocannabinol or cannabidiol); magistral preparations of cannabis plant derivatives with defined molecular content such as dronabinol (tetrahydrocannabinol); and herbal cannabis with a defined content of tetrahydrocannabinol and/or cannabidiol, together with other active ingredients (phytocannabinoids other than cannabidiol/tetrahydrocannabinol, terpenes and flavonoids). The availability of different types of CbMs/MC varies between countries worldwide. Systematic reviews of available randomised controlled trials have stated low-quality evidence for CbMs and MC for chronic neuropathic pain. Depending on the studies included in the various quantitative syntheses, authors have reached divergent conclusions on the efficacy of CbMs/MC for chronic neuropathic pain (from not effective to a clinically meaningful benefit). Clinically relevant side effects of CbMs/MC, especially for central nervous system and psychiatric disorders, have been reported by some systematic reviews. Recommendations for the use of CbMs/MC for chronic neuropathic pain by various medical associations also differ, from negative recommendations, no recommendation possible, recommended as third-line therapy, or recommended as an alternative in selected cases failing standard therapies within a multimodal concept. After reading this paper, readers are invited to formulate their own conclusions regarding the potential benefits and harms of CbMs/MC for the treatment of chronic neuropathic pain. Supplementary Information The online version contains supplementary material available at 10.1007/s40263-021-00879-w.

show abstract

Nabiximols in Chronic Neuropathic Pain: A Meta-Analysis of Randomized Placebo-Controlled Trials

Cited by 35 publications

References 54 publications

Combination Therapy for Neuropathic Pain. A Systematic Review

Combination Therapy for Neuropathic Pain. A Systematic Review

Combination Therapy for Neuropathic Pain: A Review of Recent Evidence

Cannabis-Based Medicines and Medical Cannabis for Chronic Neuropathic Pain

Contact Info

Product

Resources

About