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Table 3 Multiple sclerosis

From: Benefits and harms of medical cannabis: a scoping review of systematic reviews

Author, year Search dates; no. databases searched Funding source Nstudies Illness/condition Intervention/comparator* Outcomes Reported results AMSTAR-2 rating
Herzog, 2017 [4] Inception–mid-Dec 2016; 8 No funding 10 Chronic illness (all included studies on MS) I: Plant-derived cannabinoids
C: Standard care (anti-spasticity drugs)
• Maintenance of treatment gains
• QoL
Reported SBS L
Claflin, 2017 [23] January 17, 2018; 1 NR 7 MS I: Plant-derived cannabinoids
C: Placebo
• Pain
• Incontinence
• Spasticity
• Muscle stiffness
• VAS of most troublesome symptoms
Favors intervention for pain, incontinence, spasticity, and muscle stiffness; reported SBS for troublesome symptoms L
Behm, 2017 [24] Until 30 Nov 2017; 5 NR 4 MS I: Plant-derived and synthetic cannabinoids
C: Placebo; cannabis extract
• Gait speed Reported SBS L
Youssef, 2017 [34] 1 Jan 1946–11 Nov 2006; 4 Non-profit 3 MS I: Plant-derived cannabinoids
C: Placebo
• Decrease in incontinence episodes
• Decrease in number nocturia episodes
• Daytime voids
• Voids per 24 h
• Urgency episodes/d
• Withdrawal due to AEs
Favors intervention for decrease in incontinence episodes; reported SBS for nocturia episodes, daytime voids, voids per 24 h, urgency episodes, and withdrawal due to AEs L
Yadav, 2014 [92] First search: 1970–Mar 2011; second search (Medline only): Mar 2011 to Sept 2013; 5 Non-profit 19 MS I: All types of cannabinoids
C: Placebo
• Pain
• Central NP
• Spasticity
• Tremor
• Bladder symptoms
• Balance
• Posture
• Cognition
• Total/average AEs
Reported SBS M
Lakhan, 2009 [56] 1999–Apr 2009; 3 NR 6 MS I: Plant-derived cannabinoids
C: Placebo; THC
• Decreased spasticity
• Mobility
• Efficacy
• Ashworth score
• Walk time
• Spasticity (VAS scores)
• RMI score
• Spasticity (subjective)
Favors intervention for decreased spasticity, mobility, spasticity (VAS scores), and subjective spasticity. No statistically significant difference between groups for efficacy, Ashworth score, and RMI score. Unclear efficacy for walk time. M
Mills, 2007 [63] MEDLINE 1966, EMBASE 1988, and Cochrane to Jun 2006; 4 NR 3 MS I: Plant-derived and synthetic cannabinoids
C: Placebo
• Tremor
• Pain (VAS)
• Arm and hand function
• Ataxia
• Disability outcomes
No statistically significant difference between groups for tremor. Reported SBS for all other outcomes L
Shakespeare, 2003 [64] MEDLINE 1966, EMBASE 1988 and Cochrane to Jun 2003; 4 NR 2 MS I: Plant-derived cannabinoids
C: Placebo
• Ashworth score
• Brainstem functioning
• MS functional composite score
• Subjective global rating
• Spasms and spasticity
• Spasticity (NRS)
• Spasm frequency
No statistically significant difference between groups for Ashworth score. Only one study included for all other outcomes CL
Kuspinar, 2012 [71] Start search date varies by database to Sept 2011; 4 Non-profit 1 MS I: Plant-derived cannabinoids
C: Placebo
• Number of incontinence episodes
• QoL (incontinence questionnaire)
Reported SBS L
NICE, 2014 [91] Search updated on Feb 3, 2014; 6 Government 6 MS I: Plant-derived cannabinoids
C: Placebo
• Spasticity (Ashworth score)
• Spasticity (NRS score)
• Activities of daily living
• Spasm severity (NRS)
• Spasm severity (30% improvement in NRS)
• Timed 10 min walk
• Global impression of improvement
• Motricity
• QoL
• Guys neurological disability scale
• Adverse events
Favors intervention for spasticity (NRS score), spasm severity (30% improvement in NRS), and global impression of improvement. No statistically significant difference between groups for spasticity (Ashworth score), spasm severity (NRS), motricity, QoL, and most adverse effects. Favors control for activities of daily living and Guys neurological disability scale M
da Rovare, 2017 [27] Up to Mar 20, 2017; 4 NR 16 (24 pubs) MS or paraplegia I: Cannabinoids (not specified)
C: placebo
• Spasticity
• Spasm
• Cognitive function
• Daily activities
• Motricity
• Pain
• Bladder function
• Dizziness
• Somnolence
• Headache
• Nausea
• Dry mouth
No statistically significant differences between groups for spasticity, spasm, pain, cognitive function, daily activities, motricity, and bladder function.
Favors placebo for dizziness, somnolence, nausea, and dry mouth
M
  1. MS multiple sclerosis, NICE National Institute for Health and Care Excellence, No. number, NR not reported, NRS numerical rating scale, QoL quality of life, RMI Rivermead Mobility Index, SBS study-by-study, VAS visual analog scale
  2. *A colon indicates that there were separate analyses for each comparator