Cannabis Treatment Showcases Promising Benefits for Managing Adverse Symptoms of MS

In a recent study published in Multiple Sclerosis and Related Disorders, cannabis-based medicinal products (CBMPs) were found to boost the short- and medium-term quality of life of patients with multiple sclerosis (MS); however, more studies are necessary to draw conclusions in this area.¹

At present, efforts to reduce and manage the long-term symptoms and progression of MS utilize disease-modifying therapies (DMTs). Addressing the symptoms of MS is crucial for improving patients’ quality of life, especially considering that pain is among the most prevalent symptoms of this disease. Furthermore, the presence of neuropathic and musculoskeletal aetiologies typically guides treatment approaches, the authors added.

“In addition,” they wrote, “many individuals are affected by spasticity, for which baclofen and clonidine are the first line of therapy (Chang et al., 2013). The adverse effects and limited efficacy of symptomatic treatment is a leading cause of low drug adherence in MS patients (de Sa et al., 2011). Due to this, affected individuals often seek alternative therapies to achieve improved symptom relief.”

Cannabis Leaf | image credit: yellowj - stock.adobe.com

According to MS Society, cannabis treatment can be a useful tool in the management of pain-related and muscle spasticity symptoms in MS. An estimated 1 in every 10 patients believed to benefit from oral cannabis administration—as opposed to smoking—when other treatments have not improved their symptoms.² These benefits are supported by a 2022 study that found modest-to-moderate benefits for reducing pain and spasticity for patients with MS when administered oral cannabis or oromucosal spray.³

The present authors continued by detailing how cannabidiol (CBD) and Δ9-tetrahydrocannabinol (Δ9-THC) act on the endocannabinoid system, with cannabinoid receptors expressing themselves throughout the immune and central nervous systems and producing anti-inflammatory, analgesic, and anxiolytic effects.¹ As evidence has continually emerged in support of CBMPs to manage chronic pain, especially in MS, the authors conducted a study to further investigate changes in health-related quality of life (HRQoL) in patients with MS, as well as evaluate any related adverse effects (AEs) related to the use of CBMPs.

For this study, data were collected from the UK Medical Cannabis Registry on patients with MS beginning in December 2019 and continuing through August 2022. Patient-reported outcomes measures (PROMs) were remotely completed at 1, 3, and 6 months following the initiation of their CBMP treatment. The Multiple Sclerosis Quality of Life-54 (MSQOL-54), patient global impression of change (PGIC), Single-Item Sleep Quality Scale (SQS), General Anxiety Disorder-7 (GAD-7), and EQ-5D-5L were among the PROMs recorded.

In addition to demographic information, researchers also gathered data on alcohol (measured in units), tobacco (smoking pack years), and cannabis use (gram years—which is a measure that quantifies previous cannabis use that may influence individual tolerance to CBMP).

In total, 141 patients with MS were eligible for inclusion, with 78 individuals (55.32%) reporting current cannabis use at baseline. Throughout this cohort, the median weekly alcohol consumption was 0.00 units, lifetime tobacco and cannabis exposure was 10.00 smoking pack years, and 4.75 gram years.

The median daily dosage of THC and CBD was 210 mg and 25 mg, with the majority of patients being prescribed both (n = 138; over 97%). For 41 participants, CBMP oil was prescribed, and 22 received prescriptions for CBMP flower.

Significant improvements were seen at 1, 3, and 6 months in participant’s SQS, GAD-7, and EQ-5D-5L measures (P < .05). In regard to the GAD-7, a minimal clinically important difference (MCID) was reported by 45/118 participants (38.14%) at month 1, 30/84 participants (35.71%) at month 3, and 22/55 participants (40%) at month 6. MCID in SQS scores were reported by 45/110 (37.82%), 27/84 (32.14%), and 16/55 (29.09%) of participants at months 1, 3, and 6.

Furthermore, the authors observed significant improvements in MSQoL-54 areas such as health scale, mental health composition, cognitive functions, physical limitation or emotional problems, as well as social and sexual functioning at each follow-up (P < .05). The authors also noted that overall quality of life measures did not exhibit significant changes for the first 3 months, but significant improvements were recorded at month 6 (P < .05).

Overall, 146 AEs were reported by 21 patients. The majority of these events were considered mild (n = 47; 33.33%) or moderate (n = 72; 51.06%). Fewer events were considered severe (n = 26; 18.44%) and 1 was life-threatening. These AEs included somnolence, fatigue, muscular weakness, spasticity, and lethargy.

While these findings indicate the possible benefits CBMPs can provide for managing MS symptoms, the authors concluded by emphasizing the limitations of their study, including the lack of a control group and the risk of reporting bias from participants. Given this reality, future research should be conducted to validate the role CBMPs play in improving quality of life outcomes in patients with MS and further assess AEs.

References

1. Murphy M, Kaur V, Bui HL, et al. Clinical outcome analysis of patients with multiple sclerosis - Analysis from the UK Medical Cannabis Registry. Mult Scler Relat Disord. 2024;87:105665. doi:10.1016/j.msard.2024.105665

2. About Cannabis and MS. MS Society. Accessed May 29, 2024. https://www.mssociety.org.uk/living-with-ms/treatments-and-therapies/cannabis/about-cannabis-and-ms#:~:text=Our%20medical%20advisers%20believe%20that,health%20of%20people%20with%20MS

3. Haddad F, Dokmak G, Karaman R. The efficacy of cannabis on multiple sclerosis-related symptoms. Life (Basel). 2022;12(5):682. doi:10.3390/life12050682