Lorente Fernández L, Monte Boquet E, Pérez-Miralles F, Gil Gómez I, Escutia Roig M, Boscá Blasco I, Poveda Andrés J L, Casanova-Estruch B
Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
Neurologia. 2014 Jun;29(5):257-60. doi: 10.1016/j.nrl.2013.06.014. Epub 2013 Sep 10.
Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS.
Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression.
Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1).
THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.
痉挛是多发性硬化症（MS）患者的常见症状。本研究旨在评估δ-9-四氢大麻酚（THC）和大麻二酚（CBD）联合用药在临床实践中治疗MS痉挛的有效性和安全性。
对2008年4月至2012年3月期间接受吸入式THC/CBD治疗的患者进行回顾性观察研究。收集患者和治疗的描述性变量。根据医生的分析和总体印象评估治疗反应。
在开始使用THC/CBD治疗的56例患者中，6例因数据缺失被排除。我们评估了50例患者（42%为男性），中位年龄47.8岁（25.6 - 76.8岁）；38%被诊断为原发性进行性MS，44%为继发性进行性MS，18%为复发缓解型MS。开药的原因是痉挛（44%）、疼痛（10%）或两者皆有（46%）。16例患者因无效（7例）、停药（4例）和不良反应（5例）而停止治疗。治疗中断患者的中位暴露时间为30天，而研究结束时继续治疗患者的中位暴露时间为174天。THC/CBD对80%的患者有效，中位剂量为每天5次（2 - 10次）吸入。不良事件包括头晕（11例患者）、嗜睡（6例）、肌肉无力（7例）、口腔不适（2例）、腹泻（3例）、口干（2例）、视力模糊（2例）、激动（1例）、恶心（1例）和偏执观念（1例）。
THC/CBD似乎是标准治疗的一个良好替代方案，因为它可改善MS难治性痉挛且毒性可接受。
