Desmarais Anna, Smiddy Stephen, Reddy Sneha, El-Dallal Mohammed, Erlich Jonathan, Feuerstein Joseph D
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Ann Gastroenterol. 2020 Sep-Oct;33(5):495-499. doi: 10.20524/aog.2020.0516. Epub 2020 Jun 22.
Medical marijuana is increasingly used to control inflammation and pain in inflammatory bowel disease (IBD). We performed a meta-analysis to investigate the effect of marijuana on the clinical response, induction of clinical remission, and maintenance of clinical remission compared to placebo/standard of care.
We performed a systematic search of PubMed, Embase, and Web of Science in June 2019, for cannabis/marijuana and IBD, Crohn's disease or ulcerative colitis (UC). The statistical analysis was performed using Revman (version 5.3). GRADE methodology was used to assess the quality of the evidence.
Of the 334 studies initially reviewed, 1 trial in UC and 2 trials in Crohn's disease met eligibility. For UC, 29 patients were treated with marijuana and 31 with placebo/standard of care. There was no difference in failure to achieve clinical remission (relative risk [RR] 1.02, 95% confidence interval [CI] 0.76-1.37) or response (RR 0.99, 95%CI 0.65-1.21). Adverse events occurred in all patients receiving marijuana (RR 1.28, 95%CI 1.05-1.56). For Crohn's disease, 21 patients were treated with marijuana and 19 with placebo/standard of care. There was no difference in failure to achieve clinical remission (RR 0.72, 95%CI 0.47-1.12) or failure to achieve clinical response (RR 0.15, 95%CI 0.02-1.05). Adverse events were not reported per patient. The quality of evidence was low to very low using GRADE methodology.
Data supporting the use of marijuana for the management of IBD are extremely limited. Further well-designed studies are needed before any positive conclusions regarding marijuana use can be drawn.
医用大麻越来越多地被用于控制炎症性肠病（IBD）中的炎症和疼痛。我们进行了一项荟萃分析，以研究与安慰剂/标准治疗相比，大麻对临床反应、诱导临床缓解和维持临床缓解的影响。
2019年6月，我们对PubMed、Embase和科学网进行了系统检索，查找有关大麻/医用大麻与IBD、克罗恩病或溃疡性结肠炎（UC）的研究。使用Revman（5.3版）进行统计分析。采用GRADE方法评估证据质量。
在最初审查的334项研究中，1项关于UC的试验和2项关于克罗恩病的试验符合纳入标准。对于UC，29例患者接受大麻治疗，31例接受安慰剂/标准治疗。在未实现临床缓解（相对危险度[RR]1.02，95%置信区间[CI]0.76 - 1.37）或反应方面（RR 0.99，95%CI 0.65 - 1.21）没有差异。所有接受大麻治疗的患者均发生了不良事件（RR 1.28，95%CI 1.05 - 1.56）。对于克罗恩病，21例患者接受大麻治疗，19例接受安慰剂/标准治疗。在未实现临床缓解（RR 0.72，95%CI 0.47 - 1.12）或未实现临床反应方面（RR 0.15，95%CI 0.02 - 1.05）没有差异。未报告每位患者的不良事件。使用GRADE方法评估的证据质量为低至极低。
支持使用大麻治疗IBD的数据极其有限。在得出任何关于使用大麻的肯定结论之前，需要进一步开展设计良好的研究。
