Page 1 - The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews

Current Neurology and Neuroscience Reports (2018) 18:8
https://doi.org/10.1007/s11910-018-0814-x
NEUROLOGY OF SYSTEMIC DISEASES (J BILLER, SECTION EDITOR)

The Use of Cannabis and Cannabinoids in Treating Symptoms
of Multiple Sclerosis: a Systematic Review of Reviews

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Suzanne Nielsen 1 & Rada Germanos & Megan Weier 1,2 & John Pollard & Louisa Degenhardt & Wayne Hall &
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Nicholas Buckley & Michael Farrell 1
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Purpose of Review Pharmaceutical cannabinoids such as nabiximols, nabilone and dronabinol, and plant-based cannabinoids
have been investigated for their therapeutic potential in treating multiple sclerosis (MS) symptoms. This review of reviews aimed
to synthesise findings from high quality systematic reviews that examined the safety and effectiveness of cannabinoids in
multiple sclerosis. We examined the outcomes of disability and disability progression, pain, spasticity, bladder function, trem-
or/ataxia, quality of life and adverse effects.
Recent Findings We identified 11 eligible systematic reviews providing data from 32 studies, including 10 moderate to high
quality RCTs. Five reviews concluded that there was sufficient evidence that cannabinoids may be effective for symptoms of pain
and/or spasticity in MS. Few reviews reported conclusions for other symptoms.
Summary Recent high quality reviews find cannabinoids may have modest effects in MS for pain or spasticity. Future research
should include studies with non-cannabinoid comparators; this is an important gap in the evidence.

Keywords Multiple sclerosis . Cannabinoid . Pain . Spasticity . Nabiximols . Dronabinol . Cannabis

Introduction supporting oligodendrocytes [1]. While remyelination may
occur early in the history of the disease, over time this inflam-
Multiple sclerosis is a chronic neuroinflammatory disease of matory process results in progressive neuroaxonal loss and
the brain and central nervous system. It is characterised path- increased disability.
ologically by demyelinating plaques within both grey and The course of the condition varies in clinical form, with
white matter, representing loss of both myelin sheath and relapsing-remitting multiple sclerosis (RRMS) accounting
for approximately 85% of cases [2]. The varied signs and
symptoms of multiple sclerosis depend upon the site of lesions
in the brain and spinal cord. Common symptoms and signs
This article is part of the Topical Collection on Neurology of Systemic
Diseases
include spasticity, weakness, sensory disturbances, painful
PROSPERO registration number CRD42016051264
spasms, ataxia, tremor, optic neuritis and complex
Electronic supplementary material The online version of this article opthalmoplegias, fatigue and dysphagia [1]. There is consid-
(https://doi.org/10.1007/s11910-018-0814-x) contains supplementary erable heterogeneity in the course of the disease and its symp-
material, which is available to authorized users.
toms [3] so treatment needs to be individualised to address the
symptoms that patients report most adversely affect their qual-
* Suzanne Nielsen
suzanne.nielsen@unsw.edu.au ity of life [4].
Current drug therapies for multiple sclerosis can be
grouped into two categories: disease-modifying and symp-
1
National Drug and Alcohol Research Centre, University of New
South Wales Sydney, Sydney, NSW 2052, Australia tomatic therapies. Disease-modifying therapies aim to lessen
the number, severity and duration of relapses, maintain remis-
2
Centre for Youth Substance Abuse Research, The University of
Queensland, Royal Brisbane and Women’s Hospital Brisbane, sion and slow progression. These therapies are usually immu-
Brisbane, QLD 4006, Australia nomodulatory and/or immunosuppressive treatments such as
3 interferon beta, copaxone, fingolimod, natalizumab and
School of Medical Sciences, The University of Sydney,
Sydney, NSW 2006, Australia alemtuzumab [5–7]. Symptomatic therapies that relieve the