Efficacy, tolerability and safety of cannabinoids for management of pain in adult patients with multiple sclerosis: A systematic review and meta-analysis

IF 1 4区医学 Q3 EMERGENCY MEDICINE

Signa Vitae Pub Date : 2021-09-15 DOI:10.22514/sv.2021.157

L. Dimitrios, Fotakis Aris

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Abstract

Objective: Conduction of a systematic review and meta-analysis to determine the clinical efficacy, tolerability and safety of cannabinoids in adults patients with multiple sclerosis and intractable pain. Methods: Our review was performed according to the PRISMA guidelines. Pubmed, Scopus, Cochrane Library databases and ClinicalTrials.gov, EudraCT registries were searched for double-blind RCTs, involving adults with any form of multiple sclerosis and intractable pain. We included studies with cannabinoids of any type, dose or route of administration versus any control group. Risk of bias was assessed with Cochrane Risk of Bias 2 tool and certainty of evidence was rated according to GRADE approach. Review Manager 5.4 computer program was used to conduct our meta-analysis. Results: 6 trials, including 798 patients, were analyzed. Cannabinoids were superior to placebo for reducing pain intensity with statistical significance [MD = –0.48 (–0.88 to –0.08)]. Instead, overall withdrawals and frequency of adverse events showed a statistically significant increase in the cannabinoid groups [RR = 1.63, (1.05 to 2.52), ΝΝΤΗ = 19 (8 to 200) and RR = 1.32 (1.12 to 1.55), ΝΝΤΗ = 6 (3 to 16) respectively]. No statistical significant difference has been found on serious adverse events frequency. Short-term trials with small size and studies investigating THC/CBD spray (up to 120 mg/120 mg per day), showed a significant reduction in pain (0.90 and 0.86 points on NRS 0–10 scale respectively). Conclusions: Cannabinoids have never been administered as monotherapy and always administered by titration to treat intractable pain of various types in patients with multiple sclerosis. Our findings were based on a small number of trials and patients. Therefore certainty of evidence has been rated as moderate. Oromucosal spray THC/CBD (up to 120mg/120mg daily) is most likely to be used, in patients with multiple sclerosis and pain resistant to conventional analgesics, initially for short term treatment in future clinical practice.

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大麻素治疗成人多发性硬化症患者疼痛的有效性、耐受性和安全性：一项系统综述和荟萃分析

目的：进行系统综述和荟萃分析，以确定大麻素在成人多发性硬化症和顽固性疼痛患者中的临床疗效、耐受性和安全性。方法：我们根据PRISMA指南进行审查。检索Pubmed、Scopus、Cochrane Library数据库和ClinicalTrials.gov、EudraCT登记处的双盲随机对照试验，涉及任何形式的多发性硬化症和顽固性疼痛的成年人。我们纳入了与任何对照组相比，任何类型、剂量或给药途径的大麻素的研究。使用Cochrane偏倚风险2工具评估偏倚风险，并根据GRADE方法对证据的确定性进行评级。Review Manager 5.4计算机程序用于进行我们的荟萃分析。结果：分析了6项试验，包括798名患者。大麻素在减轻疼痛强度方面优于安慰剂，具有统计学意义[MD=-0.48（-0.88至-0.08）]。相反，大麻素组的总体停药和不良事件发生频率在统计学上显著增加[RR=1.63，（1.05至2.52），分别为19（8至200）和1.32（1.12至1.55），6（3至16）]。严重不良事件发生频率无统计学显著差异。小规模的短期试验和研究四氢大麻酚/CBD喷雾（每天高达120 mg/120 mg）的研究表明，疼痛显著减轻（NRS 0-10评分分别为0.90和0.86分）。结论：大麻类药物从未作为单一疗法使用，而是通过滴定来治疗多发性硬化症患者的各种类型的顽固性疼痛。我们的发现是基于少量的试验和患者。因此，证据的确定性被评为中等。口腔粘膜喷雾剂THC/CBD（每日高达120mg/120mg）最有可能用于多发性硬化症和对传统止痛药有耐药性的患者，最初用于未来临床实践中的短期治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Signa Vitae 医学-急救医学

CiteScore

1.30

自引率

9.10%

发文量

审稿时长

3 months

期刊介绍： Signa Vitae is a completely open-access，peer-reviewed journal dedicate to deliver the leading edge research in anaesthesia, intensive care and emergency medicine to publics. The journal’s intention is to be practice-oriented, so we focus on the clinical practice and fundamental understanding of adult, pediatric and neonatal intensive care, as well as anesthesia and emergency medicine. Although Signa Vitae is primarily a clinical journal, we welcome submissions of basic science papers if the authors can demonstrate their clinical relevance. The Signa Vitae journal encourages scientists and academicians all around the world to share their original writings in the form of original research, review, mini-review, systematic review, short communication, case report, letter to the editor, commentary, rapid report, news and views, as well as meeting report. Full texts of all published articles, can be downloaded for free from our web site.