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|Title||Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial.|
|Author(s)||Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A, on behalf of the UK|
|Journal, Volume, Issue||Lancet 2003; 362(9385): 1517-1526|
|Major outcome(s)||No effect of cannabinoids on spasticity as measured by the Ashworth scale, while patient-reported spasticity and pain decreased.|
Background: Multiple sclerosis is associated with muscle stiffness, spasms, pain, and tremor. Much anecdotal evidence suggests that cannabinoids could help these symptoms. Our aim was to test the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis.
Methods: We did a randomised, placebo-controlled trial, to which we enrolled 667 patients with stable multiple sclerosis and muscle spasticity. 630 participants were treated at 33 UK centres with oral cannabis extract (n=211), delta-9-tetrahydrocannabinol (delta-9-THC; n=206), or placebo (n=213). Trial duration was 15 weeks. Our primary outcome measure was change in overall spasticity scores, using the Ashworth scale. Analysis was by intention to treat.
Findings: 611 of 630 patients were followed up for the primary endpoint. We noted no treatment effect of cannabinoids on the primary outcome (p=040). The estimated difference in mean reduction in total Ashworth score for participants taking cannabis extract compared with placebo was 032 (95% CI 104 to 167), and for those taking delta-9-THC versus placebo it was 094 (044 to 231). There was evidence of a treatment effect on patient-reported spasticity and pain (p=0003), with improvement in spasticityreported in 61% (n=121, 95% CI 546682), 60% (n=108, 525668), and 46% (n=91, 390529) of participants on cannabis extract, delt-9-THC, and placebo, respectively.
Interpretation: Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale. However, though there was a degree of unmasking among the patients in the active treatment groups, objective improvement in mobility and patients opinion of an improvement in pain suggest cannabinoids might be clinically useful.
|Dose(s)||up to 10-25 mg THC daily depending on body weight|
|Participants||657 patients with MS|
|Type of publication||Medical journal|
|Address of author(s)||Dr John Zajicek, Peninsula Medical School, Plymouth PL6 8BX, UK (e-mail: firstname.lastname@example.org)|