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Open Access Highly Accessed Research article

Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review

Shaheen E Lakhan* and Marie Rowland

BMC Neurology 2009, 9:59  doi:10.1186/1471-2377-9-59

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Tolerability of cannabis extracts in multiple sclerosis

Magi Farre   (2010-05-12 09:24)  Pharmacoloy, MIM-Hospital del Mar-UAB. Barcelona. Spain email

We have read with interest the manuscript of Lakhan and Rowland published in the journal [1] which reviewed the efficacy of cannabis extracts in the treatment of spasticity in multiple sclerosis. We want to add some information about the tolerability of cannabis extracts.
In our study we followed a similar methodology of a systematic review of published literature, selection and meta-analysis. The papers included in our study were the same six included by Lakhan and Rowland [2-7]. Data on adverse events, induced by combined Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) therapy in comparison to placebo, were extracted independently by the authors and any disagreements were resolved by consensus. Individual adverse events were included in the analysis if described with the same or equivalent words in at least three or more of the selected works. The symptoms selected for meta-analysis (n= number of papers) were dizziness (n=6), somnolence (n=6), headache (n=5), nausea (n=4), dry mouth (n=4), fatigue (n=4), diarrhea (n=3), and constipation (n=3). Data entry and statistical analysis were performed with the use of Review Manager software (Review Manager [RevMan], 2003; RevMan 4.2.9, Cochrane Collaboration, Oxford, UK).
The results shown significant differences (odds ratio; 95% Confidence Interval) between cannabis combination and placebo in three symptoms, dizziness (OR 2.88, 1.81-4.61), dry mouth (OR 2.73, 1.58-4.72) and fatigue (OR 2.49, 1.08-5.71). Non significant differences between treatment were found in the following symptoms, nausea (OR 1.30, 0.61-2.76), somnolence (OR 1.25, 0.85-1.83), headache (OR 0.75, 0.39-1.44), diarrhea (OR 2.16, 0.75-6.24) and constipation (OR 0.64; 0.13-3.11). No serious adverse reactions were detected. Withdrawals from adverse reactions were uncommon, ranging from 0-10%. In addition, we found similar results on variables related to symptomatic relief of spasticity. In conclusion, cannabis extracts provide limited therapeutic benefit for MS spasticity symptoms with a relatively good tolerability and safety.

Magi Farre and Maria Carmen Torres
Pharmacology, IMIM-Hospital del Mar-UAB
Barcelona, Spain

References
1. Lakhan SE, Rowland M. Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review. BMC Neurol 2009;9:59.
2. Killestein J, Hoogervorst EL, Reif M, Kalkers NF, Van Loenen AC, Staats PG, Gorter RW, Uitdehaag BM, Polman CH: Safety, tolerability, and efficacy of orally administered cannabinoids in MS. Neurology 2002, 58:1404-1407.
3. Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A, UK MS Research Group: Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 2003, 362:1517-1526.
4. Wade D, Robson P, House H, Makela P, Aram J: A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil 2003, 17:21-29.
5. Vaney C, Heinzel-Gutenbrunner M, Jobin P, Tschopp F, Gattlen B, Hagen U, Schnelle M, Reif M: Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler 2004, 10:417-424.
6. Wade DT, Makela P, Robson P, House H, Bateman C: Do cannabis based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 2004, 10:434-441.
7. Collin C, Davies P, Mutiboko IK, Ratcliffe S: Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. Eur J Neurol 2007, 14:290-296.

Competing interests

No competing interests

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