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Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms.

Revista Canadian Family Physician
Año 2018
Enlaces Pubmed PubMed Central

Este artículo incluye 26 Revisiones sistemáticas Revisiones sistemáticas (26 referencias)

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OBJECTIVE: To determine the effects of medical cannabinoids on pain, spasticity, and nausea and vomiting, and to identify adverse events. DATA SOURCES: MEDLINE, the Cochrane Database, and the references of included studies were searched. STUDY SELECTION: Systematic reviews with 2 or more randomized controlled trials (RCTs) that focused on medical cannabinoids for pain, spasticity, or nausea and vomiting were included. For adverse events, any meta-analysis for the conditions listed or of adverse events of cannabinoids was included. SYNTHESIS: From 1085 articles, 31 relevant systematic reviews were identified including 23 for pain, 5 for spasticity, 6 for nausea and vomiting, and 12 for adverse events. Meta-analysis of 15 RCTs found more patients taking cannabinoids attained at least a 30% pain reduction: risk ratio (RR) of 1.37 (95% CI 1.14 to 1.64), number needed to treat (NNT) of 11. Sensitivity analysis found study size and duration affected findings (subgroup differences, CONCLUSION: There is reasonable evidence that cannabinoids improve nausea and vomiting after chemotherapy. They might improve spasticity (primarily in multiple sclerosis). There is some uncertainty about whether cannabinoids improve pain, but if they do, it is neuropathic pain and the benefit is likely small. Adverse effects are very common, meaning benefits would need to be considerable to warrant trials of therapy.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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What do Cochrane systematic reviews say about the use of cannabinoids in clinical practice?

Revista Sao Paulo medical journal = Revista paulista de medicina
Año 2018
Enlaces Pubmed DOI PubMed Central LILACS

Este artículo incluye 8 Revisiones sistemáticas Revisiones sistemáticas (8 referencias)

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ABSTRACT BACKGROUND: The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. RESULTS: Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. CONCLUSIONS: This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Cannabinoids for nausea and vomiting related to chemotherapy: Overview of systematic reviews.

Revista Phytotherapy research : PTR
Año 2018
Enlaces Pubmed DOI

Este artículo incluye 5 Revisiones sistemáticas Revisiones sistemáticas (5 referencias)

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Nausea and vomiting are common and distressing adverse events of chemotherapy. This review focuses on the findings and quality of systematic reviews (SRs) of cannabinoids for chemotherapy-induced nausea and vomiting (CINV). Review of SRs, a systematic literature search, was conducted in several electronic databases and included SRs evaluating cannabinoids for CINV in cancer patients. Methodological quality and quality of reporting were evaluated by AMSTAR and PRISMA, respectively. Initial search retrieved 2,206 records, and 5 SRs were included. On the basis of findings of the sole SR judged as high methodological quality, cannabinoids seem to be more effective than placebo, equal to prochlorperazine for reducing CINV, and to be preferred by patients. The response to different combinations of antiemetic agents seems to be equal to 1 antiemetic alone. The average of AMSTAR score was 5, and the average of PRISMA score was 13.2. Cannabinoids represent a valuable option for treating CINV, despite the adverse events related to treatment, such as drowsiness and cognitive impairment. There is no good quality evidence to recommend or not the use of cannabinoids for CINV. More studies are still needed to evaluate the effectiveness of cannabinoids when compared with modern antiemetics.

Síntesis amplia / Guía

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Guidance for the use of medicinal cannabis for the prevention or management of nausea and vomiting in Australia

Revista Therapeutic Goods Administration (TGA)
Año 2017
Enlaces tga.gov.au

Este artículo incluye 14 Revisiones sistemáticas Revisiones sistemáticas (14 referencias) 20 Estudios primarios Estudios primarios (20 referencias)

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This document reflects the evidence supporting the use of medicinal cannabis in nausea and vomiting and the recommendations of the Nausea and Vomiting Working Group

Síntesis amplia / Living FRISBEE

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¿Son efectivos los cannabinoides para el manejo de náuseas y vómitos inducidos por quimioterapia?

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Autores Morales M , Corsi O , Peña J
Revista Medwave
Año 2017
Enlaces Pubmed DOI

Este artículo incluye 16 Revisiones sistemáticas Revisiones sistemáticas (16 referencias) 61 Estudios primarios Estudios primarios (61 referencias)

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INTRODUCCIÓN: El tratamiento de las náuseas y vómitos inducidos por quimioterapia podría mejorar la calidad de vida de los pacientes oncológicos; para lograrlo se ha propuesto la adición de cannabinoides a los esquemas de antieméticos habituales. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 16 revisiones sistemáticas que en conjunto incluyen 61 estudios primarios, de los cuales cuatro son ensayos aleatorizados que responden a la pregunta de interés. Concluimos que no hay claridad respecto a si los cannabinoides otorgan un beneficio al añadirlos a esquemas antieméticos habituales para el control de náuseas y vómitos inducidos por quimioterapia, porque la certeza de la evidencia es muy baja. Probablemente aumentan los efectos adversos de manera sustantiva.

Síntesis amplia / Guía

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The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

Revista Washington, DC: The National Academies Press
Año 2017
Enlaces DOI

Este artículo incluye 77 Estudios primarios Estudios primarios (77 referencias) 22 Revisiones sistemáticas Revisiones sistemáticas (22 referencias)

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Síntesis amplia

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Cannabis: The Evidence for Medical Use

Autores Barnes, MP , Barnes, JC
Reporte Group for Drug Policy Reform
Año 2016

Este artículo incluye 124 Estudios primarios Estudios primarios (124 referencias) 25 Revisiones sistemáticas Revisiones sistemáticas (25 referencias)

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Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Efficacy, tolerability, and safety of cannabinoids for chemotherapy-induced nausea and vomiting--a systematic review of systematic reviews.

Revista Schmerz (Berlin, Germany)
Año 2016
Enlaces Pubmed DOI

Este artículo incluye 6 Revisiones sistemáticas Revisiones sistemáticas (6 referencias)

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BACKGROUND: There is growing public and legislative body support for the medical use of cannabis products, for example, for chemotherapy-induced nausea and vomiting (CINV), in Germany. METHODS: A comprehensive literature search until November 2015 was conducted in MEDLINE, DARE and Cochrane libraries for systematic reviews of randomized controlled trials (RCTs) comparing herbal or pharmaceutical cannabinoids (CB) versus placebo or conventional antiemetics for CINV. Outcomes were reduction of CINV for efficacy, drop-out rates due to adverse events for tolerability, and serious adverse events for safety. The methodology quality of the systematic reviews was evaluated by the tool assessment of multiple systematic reviews (AMSTAR). RESULTS: Six systematic reviews of RCTs included the pharmaceutical CBs dronabinol, levonantradol, and nabilone or whole plant extract (e.g., nabiximol) compared with placebo or conventional antiemetics. There was moderate quality evidence on the efficacy of CBs compared to placebo and conventional antiemetics for CINV. There was moderate quality evidence that pharmaceutical CBs were less tolerated and less safe than placebo and conventional antiemetics in CINV. One RCT examining whole plant extract was included into the systematic reviews. No RCT was found comparing CBs with neurokinine-1 receptor antagonists. CONCLUSIONS: With safe and effective antiemetics available, CBs cannot be recommended as first- or second-line therapy for CINV. Some guidelines recommend pharmaceutical CBs as third-line treatment in the management of breakthrough nausea and vomiting. Due to the lack of RCT data and safety concerns, herbal cannabis cannot be recommended for CINV.

Síntesis amplia

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[Use of cannabinoids in palliative medicine].

Autores Ernst G , Kongsgaard UE
Revista Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke
Año 2008
Enlaces Pubmed

Este artículo incluye 28 Estudios primarios Estudios primarios (28 referencias) 7 Revisiones sistemáticas Revisiones sistemáticas (7 referencias)

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BACKGROUND: Several countries use drugs containing cannabinoids for symptom management in patients that need palliative treatment. MATERIAL AND METHOD: Articles were retrieved through a literature search for randomized controlled studies of cannabinoids used to treat cancer-related symptoms such as pain, nausea and appetite. RESULTS: Evidence for clinical effect is limited. Some randomized studies have shown a treatment effect of cannabinoids in neuropathic pain. Cannabinoid-containing drugs can have a moderate anti-emetic effect and can stimulate appetite in some subgroups of patients. INTERPRETATION: Many questions about clinical efficacy and side effects have still not been answered for cannabinoid-containing drugs and there is not sufficient evidence available from relevant randomised controlled trials to base a decision on whether or not to permit such drugs in palliative care in Norway. It is however likely that drugs containing cannabinoids can help to control certain symptoms in some patients.