Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis

Abstract

Sativex is an endocannabinoid system modulator principally containing Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). During a 6-week randomised controlled trial, Sativex had a clinically relevant effect on spasticity associated with multiple sclerosis (MS). Patients self-titrated oromucosal Sativex to symptom relief or maximum tolerated dose (maximum of 130 mg THC and 120 mg CBD daily). The primary objective was to evaluate the safety and tolerability of long-term treatment by recording the incidence and severity of adverse events (AEs). Secondary outcomes were to determine evidence of developing tolerance and to assess the long-term dosing profile of Sativex. A validated 11-point Numerical Rating Scale of spasticity severity was used to assess efficacy. A total of 146 patients elected to enter this open-label follow-up safety trial. Mean treatment exposure was 334 days (standard deviation, SD = 209 days), and patients administered on average 7.3 (SD = 4.42) actuations per day. Fifty-two (36 %) patients withdrew from the study in the first year, 14 % due to AEs and 9 % due to lack of efficacy. Most AEs were mild/moderate in severity. Common (>10 %) treatment-related AEs were dizziness (24.7 %) and fatigue (12.3 %). Serious AEs occurred in five patients (3.4 %), with two psychiatric events reported by one patient. No psychoses, psychiatric AE trends, or withdrawal symptoms occurred following abrupt cessation of treatment. Baseline symptoms including spasticity did not deteriorate but were maintained to study completion in those patients who did not withdraw. No new safety concerns were identified with chronic Sativex treatment, and serious AEs were uncommon. There was no evidence of tolerance developing, and patients who remained in the study reported continued benefit.

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Acknowledgments

We thank all the patients who took part in the study, and acknowledge the assistance provided by staff at all the investigator centres. GW Pharma Ltd. had an input into the writing of this paper.

Conflicts of interest

This study was sponsored and fully funded by GW Pharma Ltd. Investigators received research grants from GW Pharma Ltd. to cover the costs of the study.

Ethical standard

All patients provided informed consent. The study has been approved by Mutli-Centre Research Ethics Committee for Scotland (MREC/01/0/99), and therefore been performed in accordance with the ethical standards laid down in 1964 Declaration of Helsinki.

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Correspondence to Michael G. Serpell.

Additional information

Sativex, a THC/CBD oromucosal spray, does not have an international nonproprietary name (INN). Nabiximols is the US Adopted Name (USAN) for it.

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Serpell, M.G., Notcutt, W. & Collin, C. Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis. J Neurol 260, 285–295 (2013). https://doi.org/10.1007/s00415-012-6634-z

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Keywords

  • Cannabinoid
  • Long-term safety
  • Multiple sclerosis
  • THC/CBD oromucosal spray
  • Spasticity