Cannabinoids for spasticity due to multiple sclerosis or paraplegia: A systematic review and meta-analysis of randomized clinical trials

Rovare, Victoria P. da; Magalhães, Gabriel P.A.; Jardini, Guilherme D.A.; Beraldo, Matheus L.; Gameiro, Mariel O.; Agarwal, Arnav; Luvizutto, Gustavo José; Paula-Ramos, Lucas; Camargo, Samira Esteves Afonso; Oliveira, Luciane Dias de; Bazan, Rodrigo; Dib, Regina El

doi:10.1016/j.ctim.2017.08.010

Cited by 36 publications

(36 citation statements)

References 37 publications

(145 reference statements)

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“…No statistically significant difference between groups for spasticity (Ashworth score), spasm severity (NRS), motricity, QoL, and most adverse effects. Favors control for activities of daily living and Guys neurological disability scaleMda Rovare, 2017 [27]Up to Mar 20, 2017; 4NR16 (24 pubs)MS or paraplegiaI: Cannabinoids (not specified)C: placebo• Spasticity• Spasm• Cognitive function• Daily activities• Motricity• Pain• Bladder function• Dizziness• Somnolence• Headache• Nausea• Dry mouthNo statistically significant differences between groups for spasticity, spasm, pain, cognitive function, daily activities, motricity, and bladder function.Favors placebo for dizziness, somnolence, nausea, and dry mouthM MS multiple sclerosis, NICE National Institute for Health and Care Excellence, No . number, NR not reported, NRS numerical rating scale, QoL quality of life, RMI Rivermead Mobility Index, SBS study-by-study, VAS visual analog scale*A colon indicates that there were separate analyses for each comparator…”

Section: Resultsmentioning

confidence: 99%

Benefits and harms of medical cannabis: a scoping review of systematic reviews

et al. 2019

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BackgroundThere has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable. We sought to conduct a scoping review of systematic reviews assessing benefits and harms of cannabis-based medicines for any condition.MethodsA protocol was followed throughout the conduct of this scoping review. A protocol-guided scoping review conduct. Searches of bibliographic databases (e.g., MEDLINE®, Embase, PsycINFO, the Cochrane Library) and gray literature were performed. Two people selected and charted data from systematic reviews. Categorizations emerged during data synthesis. The reporting of results from systematic reviews was performed at a high level appropriate for a scoping review.ResultsAfter screening 1975 citations, 72 systematic reviews were included. The reviews covered many conditions, the most common being pain management. Several reviews focused on management of pain as a symptom of conditions such as multiple sclerosis (MS), injury, and cancer. After pain, the most common symptoms treated were spasticity in MS, movement disturbances, nausea/vomiting, and mental health symptoms. An assessment of review findings lends to the understanding that, although in a small number of reviews results showed a benefit for reducing pain, the analysis approach and reporting in other reviews was sub-optimal, making it difficult to know how consistent findings are when considering pain in general. Adverse effects were reported in most reviews comparing cannabis with placebo (49/59, 83%) and in 20/24 (83%) of the reviews comparing cannabis to active drugs. Minor adverse effects (e.g., drowsiness, dizziness) were common and reported in over half of the reviews. Serious harms were not as common, but were reported in 21/59 (36%) reviews that reported on adverse effects. Overall, safety data was generally reported study-by-study, with few reviews synthesizing data. Only one review was rated as high quality, while the remaining were rated of moderate (n = 36) or low/critically low (n = 35) quality.ConclusionsResults from the included reviews were mixed, with most reporting an inability to draw conclusions due to inconsistent findings and a lack of rigorous evidence. Mild harms were frequently reported, and it is possible the harms of cannabis-based medicines may outweigh benefits.Systematic review registrationThe protocol for this scoping review was posted in the Open Access (https://ruor.uottawa.ca/handle/10393/37247).

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Section: Resultsmentioning

confidence: 99%

Benefits and harms of medical cannabis: a scoping review of systematic reviews

et al. 2019

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“…Limited literature regarding previous systematic reviews and meta-analysis was found. 6 , 7 , 8 , 9 , 10 , 11 The results from these studies were relatively incomplete.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…CBD is expected to have potential for broad therapeutic use. Potential uses of CBD alone or in combination with THC include epilepsy, pain, cancer, inflammation, anxiety, neurodegeneration, multiple sclerosis, psychotic disorders, and depression [17,18,19,20,21,22,23]. Currently, only epilepsy, cancer-related pain, and multiple sclerosis are recognized indications for CBD by international federal agencies.…”

Section: Resultsmentioning

confidence: 99%

Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use

Brown

Winterstein

2019

JCM

204

176

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Cannabidiol (CBD) is ubiquitous in state-based medical cannabis programs and consumer products for complementary health or recreational use. CBD has intrinsic pharmacologic effects and associated adverse drug events (ADEs) along with the potential for pharmacokinetic and pharmacodynamic drug–drug interactions (DDIs). Given CBD use among patients with complex conditions and treatment regimens, as well as its expanded consumer use, awareness of potential safety issues with CBD is needed. Prescribing information for federally approved products containing CBD were reviewed. Data on ADEs and DDIs were extracted and summarized. Nearly one-half of CBD users experienced ADEs, which displayed a general dose-response relationship. Common ADEs include transaminase elevations, sedation, sleep disturbances, infection, and anemia. Given CBD effects on common biological targets implicated in drug metabolism (e.g., CYP3A4/2C19) and excretion (e.g., P-glycoprotein), the potential for DDIs with commonly used medication is high. General clinical recommendations of reducing substrate doses, monitoring for ADEs, and finding alternative therapy should be considered, especially in medically complex patients. CBD is implicated as both a victim and perpetrator of DDIs and has its own ADE profile. These effects should be considered in the risk-benefit assessment of CBD therapy and patients and consumers made aware of potential safety issues with CBD use.

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Cannabinoids for spasticity due to multiple sclerosis or paraplegia: A systematic review and meta-analysis of randomized clinical trials

Cited by 36 publications

References 37 publications

Benefits and harms of medical cannabis: a scoping review of systematic reviews

Benefits and harms of medical cannabis: a scoping review of systematic reviews

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

Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use

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