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Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis
Torres-Moreno, Mari Carmen (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Papaseit, Esther (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Torrens, Marta (Institut Hospital del Mar d'Investigacions Mèdiques)
Farre, Magi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)

Data: 2018
Resum: Are medicinal cannabinoids effective and well tolerated in the treatment of multiple sclerosis? 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. Cannabinoids appear to be safe regarding serious adverse events, but their clinical benefit may be limited. This systematic review and meta-analysis of 17 randomized clinical trials including 3161 patients examines the association of efficacy and tolerability of cannabinoids with spasticity, pain, and bladder dysfunction in patients with multiple sclerosis (MS). Cannabinoids have antispastic and analgesic effects; however, their role in the treatment of multiple sclerosis (MS) symptoms is not well defined. To conduct a systematic review and meta-analysis to assess the efficacy and tolerability of medicinal cannabinoids compared with placebo in the symptomatic treatment of patients with MS. MEDLINE and the Cochrane Library Plus up to July 26, 2016. No restrictions were applied. The search was completed with information from ClinicalTrials. gov. Randomized, double-blind, and placebo-controlled trials evaluating the effect of medicinal cannabinoids by oral or oromucosal route of administration on the symptoms of spasticity, pain, or bladder dysfunction in adult patients with MS. The Preferred Reporting Items for Systematic Reviews and Meta-analyses () reporting guidelines were followed. Effect sizes were calculated as standardized mean difference (SMD) for efficacy, and rate ratio (RR) for tolerability. Within each study, those SMDs evaluating the same outcome were combined before the meta-analysis to obtain a single value per outcome and study. Pooling of the studies was performed on an intention-to-treat basis by means of random-effect meta-analysis. Spasticity (on the Ashworth and Modified Ashworth scales and subjective), pain, bladder dysfunction, adverse events, and withdrawals due to adverse events. Seventeen selected trials including 3161 patients were analyzed. Significant findings for the efficacy of cannabinoids vs placebo were SMD = −0. 25 SD (95% CI, −0. 38 to −0. 13 SD) for spasticity (subjective patient assessment data), −0. 17 SD (95% CI, −0. 31 to −0. 03 SD) for pain, and −0. 11 SD (95% CI, −0. 22 to −0. 0008 SD) for bladder dysfunction. Results favored cannabinoids. Findings for tolerability were RR = 1. 72 patient-years (95% CI, 1. 46-2. 02 patient-years) in the total adverse events analysis and 2. 95 patient-years (95% CI, 2. 14-4. 07 patient-years) in withdrawals due to adverse events. Results described a higher risk for cannabinoids. The serious adverse events meta-analysis showed no statistical significance. The results suggest a limited efficacy of cannabinoids for the treatment of spasticity, pain, and bladder dysfunction in patients with MS. Therapy using these drugs can be considered as safe. PROSPERO Identifier:.
Ajuts: Ministerio de Sanidad, Servicios Sociales e Igualdad 2015I054
Instituto de Salud Carlos III PI14/00715
Instituto de Salud Carlos III RD1270028/0009
Instituto de Salud Carlos III RD16/0017/0003
Instituto de Salud Carlos III RD16/0017/0010
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Llengua: Anglès
Document: Article ; recerca ; Versió publicada
Publicat a: JAMA network open, Vol. 1 (october 2018) , ISSN 2574-3805

DOI: 10.1001/jamanetworkopen.2018.3485
PMID: 30646241


16 p, 1.2 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Articles de recerca
Articles > Articles publicats

 Registre creat el 2020-07-06, darrera modificació el 2022-03-27



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