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Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

Abstract

INTRODUCTION

Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS.

METHODS

Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression.

RESULTS

Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1).

CONCLUSIONS

THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.

Links

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  • Authors+Show Affiliations

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    Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: lorente_lau@gva.es.

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    Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.

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    Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.

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    Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.

    ,

    Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.

    ,

    Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.

    ,

    Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.

    Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.

    Source

    Neurologia (Barcelona, Spain) 29:5 2014 Jun pg 257-60

    MeSH

    Adult
    Aged
    Analgesics, Non-Narcotic
    Cannabidiol
    Dronabinol
    Drug Therapy, Combination
    Female
    Humans
    Male
    Middle Aged
    Multiple Sclerosis
    Muscle Spasticity
    Pain
    Retrospective Studies
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Observational Study

    Language

    eng spa

    PubMed ID

    24035293

    Citation

    Lorente Fernández, L, et al. "Clinical Experiences With Cannabinoids in Spasticity Management in Multiple Sclerosis." Neurologia (Barcelona, Spain), vol. 29, no. 5, 2014, pp. 257-60.
    Lorente Fernández L, Monte Boquet E, Pérez-Miralles F, et al. Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. Neurologia. 2014;29(5):257-60.
    Lorente Fernández, L., Monte Boquet, E., Pérez-Miralles, F., Gil Gómez, I., Escutia Roig, M., Boscá Blasco, I., ... Casanova-Estruch, B. (2014). Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. Neurologia (Barcelona, Spain), 29(5), pp. 257-60. doi:10.1016/j.nrl.2013.06.014.
    Lorente Fernández L, et al. Clinical Experiences With Cannabinoids in Spasticity Management in Multiple Sclerosis. Neurologia. 2014;29(5):257-60. PubMed PMID: 24035293.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. AU - Lorente Fernández,L, AU - Monte Boquet,E, AU - Pérez-Miralles,F, AU - Gil Gómez,I, AU - Escutia Roig,M, AU - Boscá Blasco,I, AU - Poveda Andrés,J L, AU - Casanova-Estruch,B, Y1 - 2013/09/10/ PY - 2013/03/21/received PY - 2013/06/03/revised PY - 2013/06/17/accepted PY - 2013/9/17/entrez PY - 2013/9/17/pubmed PY - 2015/7/22/medline KW - Cannabidiol KW - Cannabinoides KW - Cannabinoids KW - Delta-9-tetrahidrocannabinol KW - Delta-9-tetrahydrocannabinol KW - Efectividad KW - Effectiveness KW - Esclerosis múltiple KW - Espasticidad KW - Multiple sclerosis KW - Spasticity SP - 257 EP - 60 JF - Neurologia (Barcelona, Spain) JO - Neurologia VL - 29 IS - 5 N2 - INTRODUCTION: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. METHODS: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. RESULTS: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). CONCLUSIONS: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile. SN - 1578-1968 UR - https://www.unboundmedicine.com/medline/citation/24035293/Clinical_experiences_with_cannabinoids_in_spasticity_management_in_multiple_sclerosis_ L2 - http://www.elsevier.es/en/linksolver/ft/pii/S0213-4853(13)00160-6 DB - PRIME DP - Unbound Medicine ER -