A Systematic Review Examining Cannabis Use for the Treatment of Multiple Sclerosis
Date
2019-09-24
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
0000-0002-0038-7853
Type
Thesis
Degree Level
Masters
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that affects over 2 million people worldwide. MS results in disabling and troublesome symptoms due to damage to the brain and spinal cord. Pharmaceutical options exist for the management of MS and its associated symptoms. Some individuals with MS utilize Cannabis to help manage their symptoms. Cannabinoid use in MS animal models have shown promise, and evidence supporting the indication(s) for Cannabis in MS is rapidly evolving and highly relevant to clinical practice. Currently one formulation of Cannabis (Sativex®) has Health Canada approval as an adjunct treatment option for MS-related spasticity and pain.
A systematic review was conducted to examine the literature on Cannabis-based medicine (CBM) use in MS. Medline, Embase, and International Pharmaceutical Abstracts were searched for articles related to MS and CBM in February 2018. All human studies, with outcomes specific to MS, and published in English, were eligible for inclusion. There was no publication year limit and no restrictions based on study design. Articles were screened independently by two reviewers, first by title and then by abstract. Two reviewers then independently performed data extraction on all included articles, and a quality assessment using a modified Downs and Black assessment tool. Included articles were categorized by their primary outcome into the following categories: spasticity, tremor, pain, cognition, balance/walking, bladder dysfunction, general symptoms, adverse events/safety, or disease progression. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
After removal of duplicates, 2058 articles were identified, with 60 studies meeting the inclusion criteria. Twenty-six articles were randomized controlled studies and 34 utilized a non-randomized study design. Cannabidiol and delta-9-tetrahydrocannabidiol oromucosal spray (Sativex®) was the most commonly studied CBM for MS. The dose size and frequency of administration between studies was inconsistent. Spasticity was the most common MS symptom to be treated with CBM (n=29), followed by pain (n=8) and cognition (n=6). Twenty-three studies were poor quality, 14 were fair quality, and 23 were good/excellent quality. CBM showed a trend of reducing spasticity and pain in individuals with MS; however, the variable quality of the evidence requires consideration when examining results of individual studies. Adverse events were frequent but mild, and CBM was well tolerated.
This systematic review outlines the potential of CBM to treat MS spasticity and pain, however more research is needed to examine its use for other MS symptoms. Additionally, the use of other cannabinoid products for MS treatment, the effects of administering CBM with current MS medications, and possible long-term impacts of CBM in those with MS need to be investigated further.
Description
Keywords
Multiple sclerosis, Cannabis, Cannabis-based medicine, Sativex, nabiximols, spasticity, pain
Citation
Degree
Master of Science (M.Sc.)
Department
Pharmacy and Nutrition
Program
Pharmacy