PMID- 26103030 OWN - NLM STAT- MEDLINE DCOM- 20150702 LR - 20220410 IS - 1538-3598 (Electronic) IS - 0098-7484 (Linking) VI - 313 IP - 24 DP - 2015 Jun 23-30 TI - Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. PG - 2456-73 LID - 10.1001/jama.2015.6358 [doi] AB - IMPORTANCE: Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. OBJECTIVE: To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. DATA SOURCES: Twenty-eight databases from inception to April 2015. STUDY SELECTION: Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. DATA EXTRACTION AND SYNTHESIS: Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. RESULTS: A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], -0.46 [95% CI, -0.80 to -0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, -0.36 [95% CI, -0.69 to -0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. CONCLUSIONS AND RELEVANCE: There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs. FAU - Whiting, Penny F AU - Whiting PF AD - School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom2The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals, Bristol NHS Foundation Trust. FAU - Wolff, Robert F AU - Wolff RF AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Deshpande, Sohan AU - Deshpande S AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Di Nisio, Marcello AU - Di Nisio M AD - Department of Medical, Oral, and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy5Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands. FAU - Duffy, Steven AU - Duffy S AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Hernandez, Adrian V AU - Hernandez AV AD - Medical School, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru7Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Keurentjes, J Christiaan AU - Keurentjes JC AD - Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands. FAU - Lang, Shona AU - Lang S AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Misso, Kate AU - Misso K AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Ryder, Steve AU - Ryder S AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Schmidlkofer, Simone AU - Schmidlkofer S AD - Institut fur Epidemiologie und kongenitale Erkrankungen, Cepicon GmbH, Hamburg, Germany. FAU - Westwood, Marie AU - Westwood M AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom. FAU - Kleijnen, Jos AU - Kleijnen J AD - Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom10School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Review PT - Systematic Review PL - United States TA - JAMA JT - JAMA JID - 7501160 RN - 0 (Cannabinoids) RN - 0 (Medical Marijuana) SB - IM SPIN- JAMA. 2015 Jun 23-30;313(24):2508. PMID: 26103044 EIN - JAMA. 2015 Aug 4;314(5):520. PMID: 26241608 EIN - JAMA. 2015 Aug 25;314(8):837. PMID: 26305660 CIN - Praxis (Bern 1994). 2015 Sep 30;104(20):1103-4. PMID: 26422077 CIN - Evid Based Med. 2016 Feb;21(1):17. PMID: 26490847 CIN - JAMA. 2015 Oct 27;314(16):1750-1. PMID: 26505602 CIN - JAMA. 2015 Oct 27;314(16):1751. PMID: 26505603 CIN - JAMA. 2015 Oct 27;314(16):1751-2. PMID: 26505604 EIN - JAMA. 2015 Dec 1;314(21):2308. PMID: 26624839 EIN - JAMA. 2016 Apr 12;315(14):1522. PMID: 27115278 MH - Anorexia/drug therapy MH - Cannabinoids/adverse effects/*therapeutic use MH - Chronic Pain/*drug therapy MH - Glaucoma/drug therapy MH - Humans MH - Medical Marijuana/adverse effects/therapeutic use MH - Mental Disorders/drug therapy MH - Muscle Spasticity/*drug therapy MH - Nausea/drug therapy MH - Randomized Controlled Trials as Topic MH - Tourette Syndrome/drug therapy EDAT- 2015/06/24 06:00 MHDA- 2015/07/03 06:00 CRDT- 2015/06/24 06:00 PHST- 2015/06/24 06:00 [entrez] PHST- 2015/06/24 06:00 [pubmed] PHST- 2015/07/03 06:00 [medline] AID - 2338251 [pii] AID - 10.1001/jama.2015.6358 [doi] PST - ppublish SO - JAMA. 2015 Jun 23-30;313(24):2456-73. doi: 10.1001/jama.2015.6358.