Among patients with inflammatory bowel disease (IBD), cannabinoid use was found to improve patient-reported symptoms and quality of life (QoL), however, it did not induce clinical remission or improve inflammation, according to the findings of a recently conducted systematic review with meta-analysis.
In order to determine the efficacy of cannabis and cannabinoids in the treatment of IBD, the study authors obtained randomized controlled trials (RCTs) and nonrandomized studies (NRSs) evaluating the effectiveness of any form, dose, and duration of cannabinoid consumption in IBD patients of any age. Medline, the Cochrane Central Register of Controlled Trials, and Scopus were searched to obtain pertinent studies.
Clinical remission was the primary outcome of the analysis; effect on inflammatory biomarkers, improvement in symptoms, QoL scores, and hospital outcomes were secondary outcomes. “The meta-analyses were performed using a random-effects model with subgroup analyses based on study type,” the study authors explained.
Five RCTs and 15 NRSs met inclusion criteria and were included in the analysis. A total of 146 randomized adult patients were included in the meta-analysis of the primary outcome. The risk of bias was considered to be moderate.
The study authors reported that cannabinoids were found to be ineffective at inducing remission (risk ratio, 1.56; 95% CI, 0.99-2.46) and had no effect on inflammatory biomarkers. However, significant improvements in both clinical symptoms (ie, abdominal pain, general well-being, nausea, diarrhea, and decreased appetite) as well as QoL scores were observed. The study authors also reported that cannabis use was found to be associated with shorter hospital stay lengths as well as a lower risk of parenteral nutrition, but was not found to have an effect on any other IBD complication.
Given that there is a lack of evidence on this subject, larger trials are warranted, the authors pointed out. “Until then, prescription of cannabinoids should be issued with caution. However, it may be considered in patients with a low QoL to improve symptoms, as an additive to evidence-based anti-inflammatory medication,” they concluded.
Doeve BH, van de Meeberg MM, van Schaik FDM, et al. A systematic review with meta-analysis of the efficacy of cannabis and cannabinoids for inflammatory bowel disease [published online July 14, 2020]. Journal of Clinical Gastroenterology. doi: 10.1097/MCG.0000000000001393.