Oral cannabis beneficial to MS, study suggests

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CALGARY - The first large-scale randomized trial to assess if cannabis
really does have potential benefit in treating multiple sclerosis symptoms
has produced mixed results.

There's some evidence that cannabis could be clinically useful in the
treatment of symptoms related to MS, but more work is necessary using
outcome measures that more adequately assess the effect of symptoms in
chronic disease, concluded principal investigator Dr. John Zajicek, a
neurologist at Peninsula Medical School in Plymouth, England.

In a study published in the Lancet, 630 patients with stable MS and muscle
spasticity were treated at 33 centres for 15 weeks. They received oral
cannabis extract (211 patients), D9-tetrahydrocannabinol (THC, 206 patients)
or placebo (213). The study's primary outcome was a change in overall
spasticity scores, using the Ashworth scale.

The researchers found no evidence of a difference in spasticity scores
between patients given cannabinoids compared with those given placebo.
However, the patients given cannabis did report some improvements in
spasticity and pain.

Improvement in spasticity was reported in 61%, 60% and 46% of participants
on cannabis extract, THC and placebo, respectively.

These findings are consistent with those of smaller studies which have shown
some subjective, but not observer-verified, improvement in disease-related
spasticity with the use of cannabinoids, said Dr. Zajicek.

One unexpected finding was that there were fewer hospital admissions for
relapses in the two active treatment groups compared with placebo. Also,
there was an improvement in walking time in all three groups (12% in the
patients who received THC compared with 4% in both the cannabis extract and
placebo groups).

"We now have evidence that what our patients have been telling us about
smoked cannabis holds up in a clinical trial," said neurologist Dr. Luanne
Metz, associate professor in the department of clinical neurosciences at the
University of Calgary. Further studies to evaluate cannabis as a treatment
for MS are needed, suggested Dr. Metz, author of a commentary that
accompanied the publication of the study .

"I realize the primary outcome of the study was not met but that outcome
measured one aspect of spasticity only. It doesn't correlate with function.
We need to keep that in mind when we look at other things that we now know
this drug does for people."

Current treatments for the symptom of spasticity are very limited and of
limited benefit, suggested Dr. Metz.

"They're wonderful for some people but we run up against the wall of
dose-limiting side-effects in most people that have significant spasticity,"
she said in an interview.

"We need other treatments. If we have another choice that we can add after
we've tried the standard treatments, I think that we need to consider that
like we would any other treatment, not back off because it's cannabis."

It's important to do further studies to evaluate the risks and benefits of
cannabinoids, she added, pointing out there are still legal issues and real
risks associated with smoking cannabis. "I cannot promote smoking."


Pubdate: Tuesday, November 25, 2003
Source: Medical Post, The (CN ON)
Contact: medpost@rmpublishing.com
Website: Canadian Healthcare Network |
Address: One Mount Pleasant Road Toronto, Ont. M4Y 2Y5
Fax: 416-764-3941
Copyright: 2003 The Medical Post
Author: Barbara Kermode-Scott