Der Nervenarzt

, Volume 75, Issue 10, pp 1022–1026 | Cite as

Cannabinoide bei multipler Sklerose

Chance oder Risiko?
  • Oliver Neuhaus
  • Bernd C. Kieseier
  • Ansgar Klimke
  • Wolfgang Gaebel
  • Reinhard Hohlfeld
  • Hans-Peter Hartung
Aktuelles

Zusammenfassung

Basierend auf Patientenberichten, Ergebnissen aus Tiermodellen und In-vitro-Untersuchungen ergab sich eine Reihe von Hinweisen auf einen positiven Effekt von Cannabinoiden als symptomatische Therapie der Spastik und Schmerzen bei multipler Sklerose. Mit der so genannten CAMS-Studie wurde kürzlich die erste multizentrische, randomisierte, placebokontrollierte Phase-III-Studie über die Wirkung von Cannabinoiden bei Symptomen der MS publiziert. Im primären Studienendpunkt, der Veränderung objektiv messbarer Spastizität, die in der so genannten Ashworth-Skala ausgewertet wurde, wurde zwar kein signifikanter Behandlungseffekt der Cannabinoide festgestellt, bei den sekundären Endpunkten, den subjektiven Patientenberichten, wurden dagegen signifikante Effekte auf Spastizität und Schmerz dokumentiert. Ein Hauptproblem dieser Untersuchung war die einfache Entblindung der Patienten in der aktiven Behandlungsgruppe. Die Ergebnisse der CAMS-Studie werden im Kontext mit früheren Studien, dem möglichen Wirkmechanismus sowie dem Nebenwirkungsprofil diskutiert.

Schlüsselwörter

Multiple Sklerose Symptomatische Therapie Cannabinoide 

Cannabinoids in multiple sclerosis

Opportunity or threat?

Summary

Based on patient reports, animal data, and in vitro experiments, evidence has emerged indicating a positive effect of cannabinoids as symptomatic treatment of spasticity and pain in multiple sclerosis. The recently published CAMS study was the first multicenter, randomized, placebo-controlled phase III trial to examine the efficacy of cannabinoids on symptoms related to MS. There was no treatment effect of cannabinoids on the primary outcome measure, a difference in the reduction of spasticity as assessed by the so-called Ashworth score. In contrast, significant effects on patient-reported spasticity and pain were documented. A major problem of the study was a high degree of patient unmasking in the active treatment group. In this review, the results of the CAMS study are discussed in the context of previous trials, the putative mechanism of action of cannabinoids and their adverse event profile.

Keywords

Multiple sclerosis Symptomatic therapy Cannabinoids 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Oliver Neuhaus
    • 1
    • 5
  • Bernd C. Kieseier
    • 1
  • Ansgar Klimke
    • 2
  • Wolfgang Gaebel
    • 2
  • Reinhard Hohlfeld
    • 3
    • 4
  • Hans-Peter Hartung
    • 1
  1. 1.Neurologische KlinikHeinrich-Heine-UniversitätDüsseldorf
  2. 2.Klinik und Poliklinik für Psychiatrie und PsychotherapieHeinrich-Heine-UniversitätDüsseldorf
  3. 3.Abteilung für NeuroimmunologieMax-Planck-Institut für NeurobiologieMartinsried
  4. 4.Institut für Klinische NeuroimmunologieLudwig-Maximilians-UniversitätMünchen
  5. 5.Neurologische KlinikHeinrich-Heine-UniversitätDüsseldorf

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