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A double-blind, randomized, cross-over, placebo-controlled, pilot trial with Sativex in Huntington’s disease

Abstract

Huntington’s disease (HD) is a neurodegenerative disease for which there is no curative treatment available. Given that the endocannabinoid system is involved in the pathogenesis of HD mouse models, stimulation of specific targets within this signaling system has been investigated as a promising therapeutic agent in HD. We conducted a double-blind, randomized, placebo-controlled, cross-over pilot clinical trial with Sativex®, a botanical extract with an equimolecular combination of delta-9-tetrahydrocannabinol and cannabidiol. Both Sativex® and placebo were dispensed as an oral spray, to be administered up to 12 sprays/day for 12 weeks. The primary objective was safety, assessed by the absence of more severe adverse events (SAE) and no greater deterioration of motor, cognitive, behavioral and functional scales during the phase of active treatment. Secondary objectives were clinical improvement of Unified Huntington Disease Rating Scale scores. Twenty-six patients were randomized and 24 completed the trial. After ruling-out period and sequence effects, safety and tolerability were confirmed. No differences on motor (p = 0.286), cognitive (p = 0.824), behavioral (p = 1.0) and functional (p = 0.581) scores were detected during treatment with Sativex® as compared to placebo. No significant molecular effects were detected on the biomarker analysis. Sativex® is safe and well tolerated in patients with HD, with no SAE or clinical worsening. No significant symptomatic effects were detected at the prescribed dosage and for a 12-week period. Also, no significant molecular changes were observed on the biomarkers. Future study designs should consider higher doses, longer treatment periods and/or alternative cannabinoid combinations.

Clincaltrals.gov identifier: NCT01502046

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Acknowledgments

We thank the patients and their families who participated in the trial for their endeavor. We also thank GW Pharmaceuticals for their kind support.

Author information

Correspondence to Jose Luis López-Sendón Moreno.

Ethics declarations

Funding sources for the study

This study was sponsored by Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal, GW Pharmaceuticals Ltd and Comunidad de Madrid (Grant S2010/BMD-2308).

Financial disclosure

García Caldentey, J, Trigo Cubillo, P; Ruiz Romero, C; García Ribas, G; Alonso Arias, MA; García de Yébenes M.J; Tolón Rafael, RM; Galve-Roperh, I; Resel, E; Ortega-Gutierrez, S; García-Bermejo, ML; Guzmán, M; García de Yébenes Prous, J report no disclosures.

Conflicts of interest

López-Sendón Moreno J.L.: has received travel grants from Lundbeck and Krka pharmaceuticals. No conflicts of interest to disclose. Sagredo O, Valdeolibas S and Fernández-Ruiz J are recipient of a grant from GW Pharmaceuticals.

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López-Sendón Moreno, J., García Caldentey, J., Trigo Cubillo, P. et al. A double-blind, randomized, cross-over, placebo-controlled, pilot trial with Sativex in Huntington’s disease. J Neurol 263, 1390–1400 (2016). https://doi.org/10.1007/s00415-016-8145-9

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Keywords

  • Huntington’s disease
  • Cannabinoid
  • Sativex
  • Clinical trial