Smith Paul F
Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand.
Expert Opin Drug Saf. 2005 May;4(3):443-56. doi: 10.1517/14740338.4.3.443.
The evidence for the therapeutic efficacy of cannabinoids in the treatment of multiple sclerosis (MS) is increasing but is not as yet convincing. Although several trials have reported no significant effect, the majority of the evidence which supports a beneficial effect on spasticity and pain is based on subjective measurements in trials where unblinding was likely to be a problem. The available clinical trial data suggest that the adverse side effects associated with using cannabis-based medicinal extracts (CBMEs) are generally mild, such as dry mouth, dizziness, somnolence, nausea and intoxication, and in no case did toxicity develop. However, most of these trials were run over a period of months and it is possible that other adverse side effects, not seen in these short-term studies, could develop with long-term use. Despite the evidence that cannabinoids can disrupt cognitive function and promote depression, on the basis of current data, such adverse effects seem unlikely to be associated with the use of CBMEs. Likewise, there is no evidence to suggest that their effects on balance and motor control, or immune function, may be clinically significant. There is, however, reason to be concerned about the use of therapeutic cannabinoids by people predisposed to psychosis and by pregnant women, given the increasing evidence of their adverse effects on the fetus. In conclusion, given the modest therapeutic effects of cannabinoids demonstrated so far, and the risk of long-term adverse side effects, there is reason to be cautious about their use in the treatment of MS.
大麻素用于治疗多发性硬化症（MS）的疗效证据正在增加，但尚未令人信服。尽管一些试验报告没有显著效果，但大多数支持其对痉挛和疼痛有有益作用的证据是基于试验中的主观测量，而这些试验中可能存在非盲法问题。现有的临床试验数据表明，使用基于大麻的药用提取物（CBMEs）相关的副作用通常较轻，如口干、头晕、嗜睡、恶心和中毒，且未出现毒性反应。然而，这些试验大多持续数月，长期使用可能会出现这些短期研究中未观察到的其他副作用。尽管有证据表明大麻素会干扰认知功能并引发抑郁，但根据目前的数据，这些副作用似乎不太可能与使用CBMEs有关。同样，没有证据表明它们对平衡和运动控制或免疫功能的影响具有临床意义。然而，鉴于越来越多的证据表明其对胎儿有不良影响，有精神病倾向的人和孕妇使用治疗性大麻素值得关注。总之，鉴于目前所显示的大麻素适度的治疗效果以及长期副作用的风险，在MS治疗中使用大麻素时应谨慎。
