Mixed results for marijuana
Just in time for St. Valentine’s day, the CUPID trial has published results about the use of cannabinoids (marijuana extract) in people with progressive multiple sclerosis (Ball and colleagues. Health Technol Assess 2015;19:1-188).
CUPID (for the Cannabinoid Use in Progressive Inflammatory brain Disease) was designed to evaluate whether cannabinoids could slow worsening disability in 493 people with primary- or secondary-progressive MS (PPMS, SPMS). All participants had been getting worse for at least a year and had moderate to severe disability (EDSS score 4-6). The drug tested was oral THC (tetrahydrocannabinol), the main active ingredient of marijuana, given as an oral 28-mg dose daily.
Unfortunately, THC did not have an effect on progression of disability, nor did it have an impact on MS symptoms or MRI lesions. In part this may have been due to a slow rate of progression in both the THC and placebo groups.
However, some slowing of disability appeared to be evident with THC in an analysis of a subgroup of people who had been progressing more rapidly than others, which may suggest some treatment effect (Pryce and colleagues. J Neuroimmune Pharmacol 2014; epublished December 24, 2014).
Most studies of marijuana have looked at relieving MS symptoms, primarily with an oral spray formulation of THC plus cannabidiol (CBD) (Sativex), or synthetic versions of THC taken as capsules (dronabinol, nabilone) (Marinol, Cesamet). (Only one published study has looked at smoking marijuana [Corey-Bloom and colleagues. Can Med Assoc J 2012;184:1143-1150]).
Current guidelines by the American Academy of Neurology state that cannabinoid spray is probably effective to relieve pain, urinary symptoms and muscle stiffness (Yadav & Narayanaswami. Clin Ther 2014;36:1972-1978).
Some have speculated that cannabinoids may help to regulate the immune response and reduce inflammation in the brain (Chiurchiu and colleagues. J Neuroimmune Pharmacol 2015; epublished January 20, 2015), in essence acting like other disease-modifying therapies (the injectables, orals and infusion drugs used in MS). This is why the present study investigated whether cannabinoids can reduce disease progression. The CUPID results may provide a hint of some effect, but it is likely to be minor. Better results might be seen with a cannabinoid in combination with a regular MS medication.
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