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  • ActiveMSers
    replied
    ACTRIMS 2020 POSTER SESSION

    P0439 - Cannabis Use Among People with MS: A 2020 NARCOMS Survey (ID 1483)


    SpeakersAuthors
    Presentation Number
    P0439
    Presentation Topic
    EpidemiologyBackground
    The North American Research Committee on Multiple Sclerosis (NARCOMS) registry is a voluntary self-report registry for persons with MS. Interest has been growing over time regarding the benefits of cannabis for management of various symptoms in MS, particularly as cannabis becomes more accessible.

    Objectives
    To evaluate the contemporary prevalence of cannabis use among persons with MS, and demographic factors associated with cannabis use for MS symptom management.

    Methods
    Active US NARCOMS participants were invited to complete an online, supplemental survey regarding cannabis use (excluding hemp CBD and products labeled as CBD only) for their MS symptoms. Demographic and clinical characteristics captured included age, sex, race, state of residence, age at MS symptom onset, and disability level measured using the Patient Determined Disease Steps (PDDS). Participant-reported symptoms of spasticity, pain, and sleep problems were captured using a numeric rating scale (NRS) with scores ranging from 0 (no problems) to 10 (worst possible problems). For the analysis we categorized NRS scores as 0 (normal), 1-3 (mild), 4–6 (moderate), and 7–10 (severe). We summarized the findings using descriptive statistics.

    Results
    Of the 6934 participants invited, 3249 (46.9%) responded. Most respondents were female (78.5%), Caucasian (88.5%), and had a mean (SD) age of 61.2 (10.2) years. The respondents had a mean age at symptom onset of 31.2 (10.3) years, and a median (25th, 75th) PDDS level of 3 [Gait Disability] (1 [Mild Disability], 6 [Bilateral Support]). Over 60% of respondents reported moderate to severe spasticity, pain, or sleep problems. Thirty-one percent of respondents (n=1012) indicated they had used cannabis for their MS symptoms at least once; of these respondents, 50.5% had used cannabis to treat spasticity, 43.6% had used cannabis for pain, and 38.4% had used cannabis for sleep. There were 636 (19.6%) respondents who reported current use of cannabis for their MS, while 376 (11.6%) reported past use but not current use. Current users were comparable to past users except current users were more likely to be male (p=0.001) and on average slightly younger (p=0.009).

    Conclusions
    In this US registry-based sample, 31% of participants reported ever using cannabis for MS symptoms, and 20% reported current use within the prior 30 days.

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  • ActiveMSers
    replied
    Original Article
    Published: 25 April 2020

    Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study

    Francesco Patti, Clara Grazia Chisari, […]on behalf of the SA.FE. group
    Neurological Sciences (2020)

    Abstract

    Introduction
    The approval of 9-δ-tetrahydocannabinol (THC)+cannabidiol (CBD) oromucosal spray (Sativex®) in Italy as an add-on medication for the management of moderate to severe spasticity in multiple sclerosis (MS) has provided a new opportunity for MS patients with drug-resistant spasticity. We aimed to investigate the improvement of MS spasticity-related symptoms in a large cohort of patients with moderate to severe spasticity in daily clinical practice.

    Materials and methods
    MS patients with drug-resistant spasticity were recruited from 30 Italian MS centers. All patients were eligible for THC:CBD treatment according to the approved label: ≥ 18 years of age, at least moderate spasticity (MS spasticity numerical rating scale [NRS] score ≥ 4) and not responding to the common antispastic drugs. Patients were evaluated at baseline (T0) and after 4 weeks of treatment (T1) with the spasticity NRS scale and were also asked about meaningful improvements in 6 key spasticity-related symptoms.

    Results
    Out of 1615 enrolled patients, 1432 reached the end of the first month trial period (T1). Of these, 1010 patients (70.5%) reached a ≥ 20% NRS score reduction compared with baseline (initial responders; IR). We found that 627 (43.8% of 1432) patients showed an improvement in at least one spasticity-related symptom (SRSr group), 543 (86.6%) of them belonging to the IR group and 84 (13.4%) to the spasticity NRS non-responders group.

    Conclusion
    Our study confirmed that the therapeutic benefit of cannabinoids may extend beyond spasticity, improving spasticity-related symptoms even in non-NRS responder patients.

    Leave a comment:


  • loopylady
    replied
    Originally posted by ActiveMSers View Post
    Brain Behav Immun. 2019 Jul 26. pii: S0889-1591(19)30647-6. doi: 10.1016/j.bbi.2019.07.028. [Epub ahead of print]

    Combination of cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), mitigates experimental autoimmune encephalomyelitis (EAE) by altering the gut microbiome.

    Al-Ghezi, et al

    Abstract

    Currently, a combination of marijuana cannabinoids including delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is used as a drug to treat muscle spasticity in patients with Multiple Sclerosis (MS). Because these cannabinoids can also suppress inflammation, it is unclear whether such patients benefit from suppression of neuroinflammation and if so, what is the mechanism through which cannabinoids act.

    In the currently study, we used a murine model of MS, experimental autoimmune encephalomyelitis (EAE), to study the role of gut microbiota in the attenuation of clinical signs of paralysis and inflammation caused by cannabinoids.

    THC+CBD treatment attenuated EAE and caused significant decrease in inflammatory cytokines such as IL-17 and IFN-γ while promoting the induction of anti-inflammatory cytokines such as IL-10 and TGF-β. Use of 16S rRNA sequencing on bacterial DNA extracted from the gut revealed that EAE mice showed high abundance of mucin degrading bacterial species, such as Akkermansia muciniphila (A.muc), which was significantly reduced after THC+CBD treatment. Fecal Material Transfer (FMT) experiments confirmed that THC+CBD-mediated changes in the microbiome play a critical role in attenuating EAE. In silico computational metabolomics revealed that LPS biosynthesis, a key component in gram-negative bacteria such as A.muc, was found to be elevated in EAE mice which was confirmed by demonstrating higher levels of LPS in the brain, while treatment with THC+CBD reversed this trend. EAE mice treated with THC+CBD also had significantly higher levels of short chain fatty acids such as butyric, isovaleric, and valeric acids compared to naïve or disease controls.

    Collectively, our data suggest that cannabinoids may attenuate EAE and suppress neuroinflammation by preventing microbial dysbiosis seen during EAE and promoting healthy gut microbiota.
    Thanks Dave for all you do for us and the information you share with us.

    Leave a comment:


  • loopylady
    replied
    Toneroni

    Originally posted by toneroni View Post
    Thanks for sharing this information.

    I got medical marijuana card in bakersfield for my MS and it's awesome. For me, cannabis has been extraordinarily helpful with spasticity vs prescription drugs like carbamazepine. Honestly, they had me on quite a few different anti-spasticity drugs, but that is the only one I recall at the moment. I find smoking it to be my favorite because the effects are immediate, and you can control you doses better. I’ve had success with both THC and CBD. I usually aim for a strain which is 3-5% THC and 9-15% CBD. I also make CBD coconut oil to add to tea or other things. If you have specific questions I have answers! Not that I`m an expert by any means! I’ve just had to do a lot of research on it.
    thanks for sharing. I've wondered many times if I should check into this but it concerns me because I don't really want to feel "high". My brother, God rest his soul, had Parkinson's and Crohn's...he would have taken it any way he could get it.

    Leave a comment:


  • toneroni
    replied
    Thanks for sharing this information.

    I got medical marijuana card in bakersfield for my MS and it's awesome. For me, cannabis has been extraordinarily helpful with spasticity vs prescription drugs like carbamazepine. Honestly, they had me on quite a few different anti-spasticity drugs, but that is the only one I recall at the moment. I find smoking it to be my favorite because the effects are immediate, and you can control you doses better. I’ve had success with both THC and CBD. I usually aim for a strain which is 3-5% THC and 9-15% CBD. I also make CBD coconut oil to add to tea or other things. If you have specific questions I have answers! Not that I`m an expert by any means! I’ve just had to do a lot of research on it.
    Last edited by toneroni; 02-08-2020, 05:42 AM.

    Leave a comment:


  • Suebee
    replied
    I echo Goathearder. Because it is illegal under federal law (and the minority of states) it is a treatment that may cause a MSer greater legal woes than symptomatic relief. This isn't to say it is not hugely beneficial to manage some MS symptoms, it just is not an option for all.
    Uht

    Leave a comment:


  • GoatHerder
    replied
    Not For Me

    My last neurologist kept pushing that for my symptoms, but I declined strongly.

    Because THC is still illegal under federal law, I have no desire to lose my second amendment rights to own and carry a firearm, for a few less symptoms (if it even worked for me!)

    Leave a comment:


  • ActiveMSers
    replied
    Brain Behav Immun. 2019 Jul 26. pii: S0889-1591(19)30647-6. doi: 10.1016/j.bbi.2019.07.028. [Epub ahead of print]

    Combination of cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), mitigates experimental autoimmune encephalomyelitis (EAE) by altering the gut microbiome.

    Al-Ghezi, et al

    Abstract

    Currently, a combination of marijuana cannabinoids including delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is used as a drug to treat muscle spasticity in patients with Multiple Sclerosis (MS). Because these cannabinoids can also suppress inflammation, it is unclear whether such patients benefit from suppression of neuroinflammation and if so, what is the mechanism through which cannabinoids act.

    In the currently study, we used a murine model of MS, experimental autoimmune encephalomyelitis (EAE), to study the role of gut microbiota in the attenuation of clinical signs of paralysis and inflammation caused by cannabinoids.

    THC+CBD treatment attenuated EAE and caused significant decrease in inflammatory cytokines such as IL-17 and IFN-γ while promoting the induction of anti-inflammatory cytokines such as IL-10 and TGF-β. Use of 16S rRNA sequencing on bacterial DNA extracted from the gut revealed that EAE mice showed high abundance of mucin degrading bacterial species, such as Akkermansia muciniphila (A.muc), which was significantly reduced after THC+CBD treatment. Fecal Material Transfer (FMT) experiments confirmed that THC+CBD-mediated changes in the microbiome play a critical role in attenuating EAE. In silico computational metabolomics revealed that LPS biosynthesis, a key component in gram-negative bacteria such as A.muc, was found to be elevated in EAE mice which was confirmed by demonstrating higher levels of LPS in the brain, while treatment with THC+CBD reversed this trend. EAE mice treated with THC+CBD also had significantly higher levels of short chain fatty acids such as butyric, isovaleric, and valeric acids compared to naïve or disease controls.

    Collectively, our data suggest that cannabinoids may attenuate EAE and suppress neuroinflammation by preventing microbial dysbiosis seen during EAE and promoting healthy gut microbiota.

    Leave a comment:


  • ActiveMSers
    replied
    Cannabis Use in People with Multiple Sclerosis and Self-Reported Spasticity

    Cinda Hugos1,2, Jessica Rice1,2, Michelle Cameron1,2
    1 Portland VA Health Care System
    2 Oregon Health & Science University

    Objective:
    To describe cannabis use in subjects with MS and spasticity.

    Background:
    Spasticity affects over 80% of people with MS, impacting activity, participation and quality of life. 2014 AAN systematic reviews found pharmaceutical cannabinoids (oral or oral-mucosal spray containing tetrahydrocannabinol [THC] with or without cannabidiol [CBD]) have strong (Level 1) evidence for reducing patient-reported spasticity. These products are not available in the US, but marijuana is medically (1998) and recreationally (2014) legal in Oregon. Here we describe cannabis use in subjects in Portland, Oregon, with MS and self-reported spasticity enrolling in a randomized controlled trial of education and exercise for spasticity.

    Design/Methods:
    At baseline subjects report cannabis use, the route of administration, frequency of use and perceived benefits. They also reported use of prescribed medications for spasticity. Here we report data from the first 29 subjects, with an additional 40-50 subjects to be reported at the meeting.

    Results:
    31% (9/29) reported using cannabis. Of these, 11% (1/9) reported topical use only, all others used multiple routes of administration including topical 78% (7/9), edibles 67% (6/9), or smoking, vaping and/or tinctures 33% (3/9). All subjects reported using cannabis at least once per week: 56% (5/9) used once per day or less and 44% (4/9) used more than once per day. All subjects reported cannabis being somewhat or very helpful for pain and 78% (7/9) reported similar benefit for spasticity. 89% (8/9) reported also using a prescribed medication for spasticity, with 67% (6/9) using 10-60 mg of baclofen per day.

    Conclusions:
    Where both medical and recreational marijuana are legal, but pharmaceutical cannabinoids are not available and cannot be prescribed, approximately 1/3 of people with MS and spasticity report using cannabis. Most use cannabis by multiple routes of administration, find cannabis somewhat to very helpful for both spasticity and pain and are also using prescribed antispasticity medications.

    Leave a comment:


  • ActiveMSers
    replied
    Cannabis use by Patients with Multiple Sclerosis in Colorado

    Christopher Domen et al
    University of Colorado School of Medicine

    Objective: To explore cannabis use among patients with multiple sclerosis (PwMS) treated at a large academic medical center in a state where cannabis is legal. Specifically, we examined: 1) prevalence of use, 2) patient characteristics of cannabis users (CUs) and non-users (NUs; e.g., demographics, disability status), 3) symptoms cannabis is used to manage, and 4) cannabis products used (e.g., combustable vs. edible).

    Background: Studies suggest that cannabis may be useful for the management of symptoms like pain and muscle spasticity. However, few studies have explored the profile of PwMS who are CUs and the characteristics of their use, particularly in a state where cannabis is legal recreationally and medicinally

    Design/Methods: PwMS completed a questionnaire via tablet computer assessing personal opinions about cannabis use, characteristics of cannabis use, sociodemographics, and MS history, as well as the Patient Determined Disease Steps (PDDS), Patient Reported Outcome Measure Information System (PROMIS-10), and Neuro-QoL ACGC v1.0 measures.

    Results: Of 251 respondents, 38% were current CUs. No sociodemographic differences between CUs and NUs were found (p > 0.05), but CUs reported significantly higher disability compared to NUs on the PDDS (p ≤ 0.05). Among CUs, 57% categorized their use as strictly medicinal. Among strictly medicinal CUs, 91% use products that are not combusted/smoked and 83% reported using products with at least some CBD (vs. only THC). Strictly medicinal CUs also had significantly reduced self-reported physical health on the PROMIS-10 (p ≤ 0.05) and higher reported disability on the PDDS (p ≤ 0.01). CUs reported using cannabis most often to manage pain and insomnia, with 79% reporting that they experience no side-effects.

    Conclusions:
    Legalization efforts appear to be increasing the number of PwMS seeking out cannabis as a complimentaryalternative medicine, with CUs self-reporting that their products of choice are highly efficacious and noting minimal side-effects.

    Leave a comment:


  • ActiveMSers
    replied
    Long-term Effectiveness of tetrahydrocannabinol: Cannabidiol Oromucosal Spray in Clinical Practice: results from a 18-months Multicenter Italian Study

    Francesco Patti, et al

    Objective:
    We aimed to provide real life data on clinical outcomes of a large population of Italian patients with treatmentresistant multiple sclerosis (MS) spasticity receiving 9-δ-tetrahydocannabinol and cannabidiol (THC:CBD)
    oromucosal spray (Sativex®).

    Background: THC:CBD oromucosal spray is used as mono or add-on therapy for moderate to severe MS spasticity resistant to other medications.

    Design/Methods: This 18-months observational, prospective, multicentre study evaluated patients with resistant MS spasticity treated with THC:CBD according to approved labelling. Data were collected from the mandatory Italian medicines agency (AIFA) e-registry from January 2015 to June 2018. Spasticity assessment with the 0-10 numerical rating scale (NRS) was performed at baseline, after 1 month of treatment (T1) and every 6 months until 18 months (T4) from the treatment initiation.

    Results: A total of 1845 patients were recruited from 32 Italian MS centres. At T1, 1502 (81.4%) of patients reached an NRS improvement of ≥20% and 814 (40.2%) a of ≥30%, with a mean NRS score reduction of 28.9% at T1 and of 36.8% at T4. Daily number of puffs was generally stable through the observation period (6.9±2.4 at T1 vs 6.3±3.1 at T4, p=0.8). At T4, 727 (39.4%) patients have discontinued treatment; 388 (53.4%) because of lack of effectiveness and 339 (46.6%) for adverse events: 127 (37.5%) reported vertigo, 118 (34.8%) sleepiness, 96 (28.3%) worsening of fatigue, and 54 (15.9%) cognitive symptoms. The multivariate analysis showed that higher NRS score at baseline (OR 2.21 95%CI 1.12-6.28, p<0.01) and higher difference of NRS between T1 and baseline (OR 2.03 95%CI 1.04-8.14, p<0.05) were associated to an increased probability to stay on therapy after 18 months.

    Conclusions: Real-life data from a large Italian MS population confirmed the long-term effectiveness of THC:CBD for the treatment of resistant MS spasticity in everyday clinical practice. Treatment effects were sustained for 18-months with a relatively stable number of puffs/day.

    Leave a comment:


  • ActiveMSers
    replied
    More from 2019's AAN conference currently ongoing in Seattle.

    Multiple Sclerosis and Use of Medical Cannabis: A Retrospective Review Evaluating Symptom Outcomes

    Katelyn McCormack, et al

    Objective:
    The purpose of this study was to investigate the role of medical cannabis in improving symptomatology in patients diagnosed with multiple sclerosis (MS). We also sought to collect data on other pertinent outcomes related to the use of cannabis to enhance understanding of the potential benefits this complementary therapy offers.

    Background:
    Although medical cannabis is approved in 30 states and the District of Columbia for use in multiple sclerosis there remains a dearth of research clinically evaluating its effectiveness and patient experience.

    Design/Methods:
    A retrospective chart review of 77 patients diagnosed with multiple sclerosis participating in treatment with medical cannabis for symptom management was conducted (F=53, M=24, Mean Age=49±12). A variety of objective and subjective variables that pertain to alleviation of MS symptoms were collected from each of the first four appointments following initiation of medical cannabis. A cross-sectional review of self-rating scales completed by patients was also conducted to determine gross changes in mental health.

    Results:
    Subjective improvement endorsed by patients was extensive, with alleviation of symptomatology seen most in pain (71%), spasticity (43%), and sleep (42%). In addition, 34% of patients were able to decrease and discontinue other medications including opioids, stimulants, and benzodiazepines (McNemar's test for symmetry; p<0.001), indicative of symptom improvement. Medical cannabis was also well-tolerated within the multiple sclerosis patient population. The most common adverse reaction observed was somnolence (6%). No significant weight change was noted over 335 day average duration of therapy. A low rate of discontinuation (14%) was observed, most frequently due to cost (36%) and lack of efficacy (36%).

    Conclusions:
    Patients with multiple sclerosis who initiated medical cannabis treatment experienced improved symptomology with good tolerability and were able to decrease or altogether discontinue opioids, stimulants and benzodiazepines. Further controlled studies are needed to confirm and clarify these results.

    Leave a comment:


  • Suebee
    replied
    Ditto! Thanks for keeping us informed.

    I point out that it is yet another example of anecdotal evidence that something helps patients with "invisible disease" to later garner scientific proof....

    Leave a comment:


  • Fit Paul
    replied
    Amazing. Thanks for your work compiling this information.

    Leave a comment:


  • ActiveMSers
    replied
    This just posted. Interesting. - D

    Target regulation of PI3K/Akt/mTOR pathway by cannabidiol in treatment of experimental multiple sclerosis

    Sabrina Giacoppoa, Federica Pollastrob, Gianpaolo Grassic, Placido Bramantia, Emanuela Mazzona

    Received 26 September 2016, Revised 11 November 2016, Accepted 19 November 2016, Available online 25 November 2016

    Abstract

    This study was aimed to investigate whether treatment with purified cannabidiol (CBD) may counteract the development of experimental multiple sclerosis (MS), by targeting the PI3K/Akt/mTOR pathway. Although the PI3K/Akt/mTOR pathway was found to be activated by cannabinoids in several immune and non-immune cells, currently, there is no data about the effects of CBD in the PI3K/Akt/mTOR activity in MS.

    Experimental Autoimmune Encephalomyelitis (EAE), the most common model of MS, was induced in C57BL/6 mice by immunization with myelin oligodendroglial glycoprotein peptide (MOG)35–55. After EAE onset, which occurs approximately 14*days after disease induction, mice were daily intraperitoneally treated with CBD (10*mg/kg mouse) and observed for clinical signs of EAE. At 28*days from EAE-induction, mice were euthanized and spinal cord tissues were sampled to perform immunohistochemical evaluations and western blot analysis.

    Our results showed a clear downregulation of the PI3K/Akt/mTOR pathway following EAE induction. CBD treatment was able to restore it, increasing significantly the phosphorylation of PI3K, Akt and mTOR. Also, an increased level of BNDF in CBD-treated mice seems to be involved in the activation of PI3K/Akt/mTOR pathway. In addition, our data demonstrated that therapeutic efficacy of CBD treatment is due to reduction of pro-inflammatory cytokines, like IFN-γ and IL-17 together with an up-regulation of PPARγ. Finally, CBD was found to promote neuronal survival by inhibiting JNK and p38 MAP kinases.

    These results provide an interesting discovery about the regulation of the PI3K/Akt/mTOR pathway by cannabidiol administration, that could be a new potential therapeutic target for MS management.

    Leave a comment:

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