Cannabinoids for Medical Use A Systematic Review and Meta-analysis

2.50
Hdl Handle:
http://hdl.handle.net/10757/558499
Title:
Cannabinoids for Medical Use A Systematic Review and Meta-analysis
Authors:
Whiting, Penny F.; Wolff, Robert F.; Deshpande, Sohan; Di Nisio, Marcello; Duffy, Steven; Hernández, Adrian V. ( 0000-0002-9999-4003 ) ; Keurentjes, J. Christiaan; Lang, Shona; Misso, Kate; Ryder, Steve; Schmidlkofer, Simone; Westwood, Marie; Kleijnen, Jos
Publisher:
American Medical Association
Journal:
Journal of the American Medical Association (JAMA)
Issue Date:
24-Jun-2015
URI:
http://hdl.handle.net/10757/558499
DOI:
10.1001/jama.2015.6358
Additional Links:
http://jama.jamanetwork.com/article.aspx?articleid=2338251
Abstract:
Importance Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. Objective To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. Data Sources Twenty-eight databases from inception to April 2015. Study Selection Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. Data Extraction and Synthesis Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Main Outcomes and Measures Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. Results A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], −0.46 [95% CI, −0.80 to −0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, −0.36 [95% CI, −0.69 to −0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. Conclusions and Relevance There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Keywords:
Cannabinoids
ISSN:
0098-7484
EISSN:
1538-3598

Full metadata record

DC FieldValue Language
dc.contributor.authorWhiting, Penny F.es_PE
dc.contributor.authorWolff, Robert F.es_PE
dc.contributor.authorDeshpande, Sohanes_PE
dc.contributor.authorDi Nisio, Marcelloes_PE
dc.contributor.authorDuffy, Stevenes_PE
dc.contributor.authorHernández, Adrian V.es_PE
dc.contributor.authorKeurentjes, J. Christiaanes_PE
dc.contributor.authorLang, Shonaes_PE
dc.contributor.authorMisso, Katees_PE
dc.contributor.authorRyder, Stevees_PE
dc.contributor.authorSchmidlkofer, Simonees_PE
dc.contributor.authorWestwood, Mariees_PE
dc.contributor.authorKleijnen, Joses_PE
dc.date.accessioned2015-06-24T14:25:53Zes_PE
dc.date.available2015-06-24T14:25:53Zes_PE
dc.date.issued2015-06-24es_PE
dc.identifier.issn0098-7484es_PE
dc.identifier.doi10.1001/jama.2015.6358es_PE
dc.identifier.urihttp://hdl.handle.net/10757/558499es_PE
dc.description.abstractImportance Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. Objective To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. Data Sources Twenty-eight databases from inception to April 2015. Study Selection Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. Data Extraction and Synthesis Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Main Outcomes and Measures Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. Results A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], −0.46 [95% CI, −0.80 to −0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, −0.36 [95% CI, −0.69 to −0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. Conclusions and Relevance There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.eng
dc.formatapplication/pdfes_PE
dc.language.isoenges_PE
dc.publisherAmerican Medical Associationes_PE
dc.relation.urlhttp://jama.jamanetwork.com/article.aspx?articleid=2338251es_PE
dc.rightsinfo:eu-repo/semantics/openAccesses_PE
dc.sourceUniversidad Peruana de Ciencias Aplicadas (UPC)es_PE
dc.sourceRepositorio Académico - UPCes_PE
dc.subjectCannabinoidses_PE
dc.titleCannabinoids for Medical Use A Systematic Review and Meta-analysises_PE
dc.typeinfo:eu-repo/semantics/articlees_PE
dc.identifier.eissn1538-3598es_PE
dc.identifier.journalJournal of the American Medical Association (JAMA)es_PE
dc.description.fundingThis funded by the Swiss Federal Office of Public Health (FOPH) under grant agreement 14.001443/204.0001/-1257es_PE
dc.description.peer-reviewRevisión por pareses_PE
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