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
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.
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
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/ Revisión panorámica de revisiones sistemáticas
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.
INTRODUCTION: Nausea and vomiting occur in 40-70% of people with cancer, and are also common in other chronic conditions such as hepatitis C and inflammatory bowel disease. Nausea and vomiting become more common as disease progresses.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for nausea and vomiting occurring either as a result of the disease or its treatment, in adults with cancer? What are the effects of treatments for nausea and vomiting occurring either as a result of the disease or its treatment, in adults with chronic diseases other than cancer? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5HT(3) antagonists, antihistamines, antimuscarinics, atypical antipsychotics, benzodiazepines, butyrophenones, cannabinoids, corticosteroids, haloperidol, metoclopramide, NK1 antagonists, phenothiazines, prokinetics, 5HT(3) antagonists plus corticosteroids, and venting gastrostomy.
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.
Revista»Seville: Andalusian Agency for Health Technology Assessment (AETSA)
Año»2005
Cargando información sobre las referencias
RESUMEN: El objetivo de las respuestas rápidas es orientar al solicitante sobre aspectos concretos de la tecnología y plantear posibles líneas de trabajo. En este caso se centra en recopilar los documentos más relevantes y sintetizar sus conclusiones, proporcionando información que valore la seguridad y la potencial eficacia/efectividad del uso terapéutico del cannabis, centrándonos en la mejora de la calidad de vida de los pacientes. Se realizó una búsqueda para localizar informes de agencias de evaluación, revisiones sistemáticas, así como otros documentos relevantes para la toma de decisiones (legislación, etc). Se realizó una lectura y una síntesis cualitativa, valorando para ello la metodología empleada en la realización de los distintos estudios, así como la fecha de su realización. Se han encontrado revisiones sistemáticas en dos indicaciones: control de las náuseas y los vómitos en pacientes sometidos a quimioterapia, y control del dolor. Respecto a las náuseas y los vómitos, aunque los cannabinoides fueron ligeramente mejores que los antieméticos con los que se compararon, los efectos adversos fueron frecuentes. Con la evidencia disponible, no debería recomendarse su uso generalizado, aunque sí podría considerarse como una opción en pacientes en los que el resto de tratamientos no sean efectivos. Esta posibilidad de dispensación ya está cubierta con la disponibilidad en los hospitales de la nabilona como medicamento extranjero. Respecto al dolor, fue el de tipo oncológico el más estudiado, aunque con resultados contrapuestos. Con los datos disponibles, todavía no podríamos considerar los cannabinoides como una opción en el tratamiento de ninguno de los tipos de dolor, aunque parece que existen posibilidades terapéuticas que se deberían investigar. No se ha encontrado suficiente evidencia para respaldar el uso de los cannabinoides en las otras indicaciones, aunque existen indicios que deberían ser considerados a la hora de plantear nuevas investigaciones, especialmente en los síntomas de la esclerosis múltiple.
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.
