Medical marijuana may hold some promise for treating chemotherapy-induced nausea and vomiting (CINV) and seizures in children and adolescents, a new systematic review and meta-analysis published in the November issue of Pediatrics suggests.
“Evidence for benefit [of medical marijuana] was strongest for chemotherapy-induced nausea and vomiting, with increasing evidence of benefit for epilepsy,” write Shane Shucheng Wong, MD, and Timothy E. Wilens, MD, both from Massachusetts General Hospital, Boston. However, “[a]t this time, there is insufficient evidence to support use for spasticity, neuropathic pain, posttraumatic stress disorder, and Tourette syndrome.”
Two synthetic cannabinoids, dronabinol and nabilone, have been approved by the US Food and Drug Administration for medical use in the United States.
Nevertheless, according to the authors, the legalization of medical marijuana has only widened the gap between its accessibility and the limited evidence for using cannabinoids as medical treatment in pediatric patients.
Dr Wong and Dr Wilens therefore examined the evidence base of cannabinoids as a medical treatment in children and adolescents.
They conducted a systematic review and meta-analysis of studies investigating the medical benefits of cannabinoids for young patients. Their study comprised 795 patients in 22 pediatric studies, including six on CINV and 11 on epilepsy.
The studies examined included five randomized controlled trials (RCTs), five case reports, five retrospective chart reviews, four open-label trials, two parent surveys, and a single case series.
Among the studies in CINV, four of which were RCTs, the researchers found that medical cannabinoids performed significantly better than conventional antinausea drugs for reducing CINV in young patients.
“This evidence parallels the adult literature,” the authors write.
For example, one study reporting on two double-blind RCTs showed that δ-9-tetrahydrocannabinol significantly reduced nausea and vomiting compared with metoclopramide (P < .01) and prochlorperazine (P < .001).
The epilepsy studies also showed that medical cannabinoids reduced the frequency of seizures in patients, including among some with treatment-resistant epilepsy.
For example, the single RCT in epilepsy involved patients with drug-resistant seizures associated with Dravet syndrome. Those who received cannabidiol experienced a significantly (P = .01) greater reduction in the median frequency of monthly convulsive seizures (from 12.4 to 5.9) compared with those who received placebo (from 14.9 to 14.1).
“This represented an adjusted reduction in median seizure frequency by 22.9% with [cannabidiol] in comparison with a placebo,” the authors say.
However, beyond its potential use in CINV and epilepsy, Dr Wong and Dr Wilens found insufficient evidence to support use of medical cannabinoids to treat other clinical indications, such as spasticity, neuropathic pain, posttraumatic stress disorder, and Tourette syndrome.
“Additional larger, prospective, and controlled studies are required to better delineate the medical utility of cannabinoids in different pediatric disorders,” the authors conclude.
The authors have reported no relevant financial relationships.
Pediatrics. 2017;140(5):e20171818. Abstract
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