THC/CBD oromucosal spray in patients with multiple sclerosis overactive bladder: a pilot prospective study

Abstract

Lower urinary tract dysfunctions (LUTDs) are commonly reported in multiple sclerosis (MS) patients and are mainly related to neurogenic overactive bladder (OAB). The aim of this observational study was to assess the effect of a tetrahydrocannabinol-cannabidiol (THC/CBD) oromucosal spray on resistant OAB by means of clinical and instrumental tools. Twenty-one MS patients were screened, and 15 cases have been evaluated. They underwent a specific clinical assessment (overactive bladder symptom score, OABSS) and a urodynamic assessment evaluating the maximal cystometric capacity (CCmax), bladder compliance (Qmax), maximum detrusor pressure (Pdet max), detrusor pressure at the first desire (Pdet first), bladder volume at the first desire (BVFD), leakage volume (LV), and post-void residual volume (PVR), before and after 4 weeks of THC/CBD administration. A complete neurological evaluation, including the assessment of their spasticity using the Modified Ashworth Scale (MAS) and the spasticity 0-10 numerical rating scale (NRS), was performed at the same times. Mobility was evaluated through the 25-ft walking-time test (T25-WT). The THC/CBD treatment successfully reduced the OAB symptoms (p = 0.001). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016), while BVFD and CCmax were increased although the difference was not statistically significant. THC/CBD oromucosal spray has shown to be effective in improving overactive bladder symptoms in MS patients demonstrating a favorable impact on detrusor overactivity.

Gabapentin add-on therapy for patients with spinal cord injury associated neurogenic overactive detrusors that are unresponsive to combined anticholinergic and beta-3 adrenergic therapy

“…In experimental fashion, inosine, resiniferatoxin, an E-series prostaglandin 1 receptor antagonist, kynurenine gene transfer via viruses, gamma-aminobutyric acid A and B receptor agonists muscimol and baclofen, a transient receptor potential 1 and a transient receptor potential vanilloid 1 receptor antagonists, an arginase inhibitor, a prostacyclin receptor antagonist, an endothelin-A receptor antagonist, and memantine have been shown to be beneficial [ 24 – 33 ]. Clinical studies have indicated that mirabegron, tetrahydrocannabinol-cannabidiol oral spray, anticholinergic preparations, and gabapentin are effective in the management of a neurogenic overactive detrusor [ 13 – 18 , 34 , 35 – 39 ]. However, there is still a group of patients who are unresponsive to the combination of an anticholinergic with the β-adrenergic therapeutic.…”

Current pharmacotherapy of overactive bladder

“…In a 2016 study of 15 patients, cannabidiol/tetrahydrocannabinol (THC/ CBD) oral-mucosal spray administered for four weeks was found to improve overactive bladder symptoms. Although not statistically significant, there was a modest increase in maximum bladder capacity and bladder volume at first desire to urinate (125). Obvious safety concerns exist for using cannabinoid receptor agonists in able-bodied OAB subjects but development of selective activators that do not have systemic effects is a promising avenue for the future.…”

Managing Urological Disorders in Multiple Sclerosis Patients: A Review of Available and Emerging Therapies

“…A recent metaanalysis [18] showed the promise of cannabinoids as a safe and effective treatment modality for neurogenic LUTD in MS patients, as cannabinoids led to a meaningful reduction in the number of incontinence episodes in all 3 studies that were included in the meta-analysis. In addition, a recent observational study used clinical tools and instrumental analyses to evaluate the effects of a tetrahydrocannabinol-cannabidiol (THC/CBD) oromucosal spray on resistant OAB in MS patients [19]. The THC/CBD spray was successful in reducing OAB symptoms (P = 0.001), suggesting that it might be effective for improving OAB symptoms in patients with MS, with beneficial effects on DO.…”