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Clínica médica/Intensiva/Enfermagem

Canabinóides no tratamento da esclerose múltipla: existem benefícios para os pacientes?

10/11/2003
 

 

O emprego de canabinóides no tratamento de diversas doenças crônicas há muito vem sendo debatido. Artigo publicado no jornal The Lancet descreve estudo multicêntrico randomizado conduzido por pesquisadores do Reino Unido no qual se buscou avaliar a utilidade deste tipo de tratamento com relação aos sintomas da esclerose múltipla.Concluiu-se que os efeitos benéficos da terapia foram todos relacionados à melhora dos quadros de dor, mas não dos distúrbios do movimento.

The Lancet

 

Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial

John Zajicek, Patrick Fox, Hilary Sanders, David Wright, Jane Vickery, Andrew Nunn, Alan Thompson, on behalf of the UK MS Research Group*


*Members listed at end of paper


Peninsula Medical School, Plymouth, UK (J Zajicek FRCP, P Fox MB, J Vickery BSc); School of Mathematics and Statistics, University of Plymouth, Plymouth, UK (H Sanders BSc, D Wright PhD); Medical Research Council Clinical Trials Unit, London, UK (Prof A Nunn MSc); National Hospital for Neurology and Neurosurgery, University College Hospitals, London, UK (Prof A Thompson FRCP)


Correspondence to: Dr John Zajicek, Peninsula Medical School, Plymouth PL6 8BX, UK (e-mail:john.zajicek@phnt.swest.nhs.uk)

Summary

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), Delta9-tetrahydrocannabinol (Delta9-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=0·40). The estimated difference in mean reduction in total Ashworth score for participants taking cannabis extract compared with placebo was 0·32 (95% CI -1·04 to 1·67), and for those taking Delta9-THC versus placebo it was 0·94 (-0·44 to 2·31). There was evidence of a treatment effect on patient-reported spasticity and pain (p=0·003), with improvement in spasticity reported in 61% (n=121, 95% CI 54·6-68·2), 60% (n=108, 52·5-66·8), and 46% (n=91, 39·0-52·9) of participants on cannabis extract, Delta9-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.

Lancet 2003; 362: 1517-26


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