This May, in honour of Multiple Sclerosis Awareness Month in Canada and World Multiple Sclerosis Day (May 30th), this article summarizes three studies on how medical cannabis can potentially help to manage symptoms of MS. 

What is multiple sclerosis?

Multiple Sclerosis (MS) is a central nervous system autoimmune disease that leads to symptoms such as spasticity, weakness, pain, fatigue, lack of coordination, cognitive impairment and altered mood.²

Canada has one of the highest rates of MS globally, with women three times more likely to develop MS than men.¹ There is currently no cure though there are treatment options to mitigate disease symptoms.²

Balanced 1:1 Extracts May Ease Symptoms of MS

There is evidence that a balanced THC:CBD oromucosal extract may be effective in reducing spasticity^3–6, pain^7,8 and sleep disturbances^6,7 in patients with MS. Additionally, a meta-analysis of three studies that examined the efficacy of a balanced THC:CBD oromucosal extract in patients with MS suggested that it was well tolerated and can be ended abruptly without any risk.  

This study concluded that patients who have uncontrolled symptoms after treatment with traditional pharmaceuticals could trial a balanced THC:CBD oromucosal extract for 4 weeks to see if they respond.³

Study 1: Balanced Extract as Add-On Therapy for MS

In a double-blind, placebo-controlled, randomized clinical trial by Markovà et al., a balanced THC:CBD oromucosal extract was used as an add-on therapy in a two-phase trial.⁴ Phase A included the treatment with the extract for 4 weeks. If patients responded, they were randomized to receive the extract or placebo for 12 weeks in Phase B.⁴ 

Of the initial 191 patients included in Phase A, 106 patients continued onto Phase B (n=53 with the balanced THC:CBD oromucosal extract and n=53 with placebo).⁴   

The result was a significantly greater proportion of patients receiving the extract were found to have responded well. This outcome was determined as ≥30% improvement from baseline via a numerical rating scale (NRS) in comparison to the placebo arm.⁴

•    Spasticity: Treatment with the balanced THC:CBD oromucosal extract led to significant improvements in mean spasticity and mean modified Ashworth’s scale from Phase B baseline to week 12 in comparison to placebo.⁴
  
  
•    Pain: Markovà and her team also found that treatment with the balanced THC:CBD oromucosal extract led to significant improvements in pain symptoms in comparison to the placebo-treated group after 12 weeks.⁴ 
  
  
•    Sleep: Treatment with the balanced THC:CBD oromucosal extract also limited sleep disruptions to a significantly greater extent than the placebo treatment did, with the extract reducing the sleep disruption NRS score by 3.21 while the placebo treatment reduced it by 1.78.⁴ 

Study 2: Retrospective Study of 1,615 MS Patients 

A retrospective study of 1,615 MS patients across Italy found that after 4 weeks of treatment with a balanced THC:CBD oromucosal extract: 

70.5% of the patients had a change in their ≥20% NRS score and were considered initial spasticity responders.⁹ 

43.8% of the total patient group that completed 4 weeks of treatment showed improvement in at least one spasticity related symptom, with 86.6% of these patients categorized as responders.⁹ 

27.9% of patients reported meaningful improvements in their cramps/nocturnal spasms and 12.1% and 11.5% had reduced bladder disorders and pain, respectively.⁹

Overall, this study concluded that a progressive MS phenotype and a higher NRS score at baseline were associated with an increased probability to report an improvement in spasticity-related symptoms after 4 weeks of treatment with a balanced THC:CBD 1:1 oromucosal spray.⁹

Study 3: The Effect of Cannabis on Clinical and Cytokine Profiles of MS Patients

Mustafa et al. examined the effect cannabis has on the clinical and cytokine profiles of patients with MS.¹⁰ Over the course of a year (January 2019-January 2020), 150 MS patients and 150 healthy controls were recruited to participate in this prospective case control study.¹⁰ The MS patient group was divided into patients who consumed cannabis (n=28) and patients who did not (n=122).¹⁰

There was a significant difference in sex composition between the three groups: 76.23% of the MS patient group who did not consume cannabis were female, while males made up 71.4% of the MS patient group who consumed cannabis and 52% of the healthy control group.¹⁰ 

The number of relapses was significantly lower, and the Expanded Disability Status Scale (EDSS) score was significantly improved in the MS patient group who consumed cannabis in comparison to the MS group who did not consume cannabis.¹⁰

MS patients who consumed cannabis had significantly less pain, spasms, fatigue, difficulty walking, anxiety and mood changes but no differences in sexual dysfunction, bladder symptoms or visual disturbances in comparison to the MS patient group who did not consume cannabis.¹⁰

Furthermore, while the healthy controls had the best cytokine profile, the MS patients who consumed cannabis had significantly lower levels of pro-inflammatory cytokines but higher levels of anti-inflammatory cytokines than the MS group who did not consume cannabis.¹⁰

In Conclusion

At Aurora®, we always stay up to date on the latest scientific research surrounding the effectiveness of medical cannabis. We hope this information has been helpful to you in making the most well-informed decisions for your health and wellness.   

This May 30th -- join tens of thousands of Canadians online in support of MS Walk!

Register online to the community and/or donate by clicking here. 

References:

1. Multiple Sclerosis Awareness Month | Cochrane Canada. https://multiplesclerosisnewstoday.com/news-posts/2021/05/07/canada-ms-walk-awareness-month/

2. What is MS? — MS Society of Canada. https://mssociety.ca/about-ms/what-is-ms

3. Wade DT, Collin C, Stott C, Duncombe P. Meta-analysis of the efficacy and safety of Sativex (nabiximols), on spasticity in people with multiple sclerosis. Mult Scler. 2010;16(6):707-714.

4. Markovà J, Essner U, Akmaz B, Marinelli M, Trompke C, Lentschat A, Vila Silván C. Sativex® as Add-on therapy Vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. Int J Neurosci. May 2018:1-28.

5. Wade DT, Makela PM, House H, Bateman C, Robson P. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler. 2006;12(5):639-645.

6. Wade DT, Makela P, Robson P, House H, Bateman C. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler J. 2004;10(4):434-441.

7. Rog DJ, Nurmikko TJ, Friede T, Young CA. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology. 2005;65(6):812-819.

8. Rog D, Nurmikko T, Young C. Oromucosal Δ9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: An uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007;29(9):2068-2079.

9. Patti F, Chisari CG, Solaro C, Benedetti MD, Berra E, Bianco A, Bruno Bossio R, Buttari F, Castelli L, Cavalla P, Cerqua R, Costantino G, Gasperini C, Guareschi A, Ippolito D, Lanzillo R, Maniscalco GT, Matta M, Paolicelli D, et al. Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study. Neurol Sci. 2020;41(10):2905-2913.

10. Mustafa W, Elgendy N, Salama S, Jawad M, Eltoukhy K. The Effect of Cannabis on the Clinical and Cytokine Profiles in Patients with Multiple Sclerosis. Mult Scler Int. 2021;2021:1-10.