Medical cannabis shows encouraging results in multiple sclerosis patients

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, affecting around 130,000 people in France, the majority of them young women (aged between 25 and 35 at diagnosis). It manifests itself through a wide variety of symptoms: motor, visual, cognitive or sensory disorders. Among these, spasticity - painful muscle stiffness - affects up to 80% of patients during the course of the disease. When this spasticity no longer responds to conventional treatments, we speak of rebellious painful spasticity, a burdensome symptom with a strong impact on patients' quality of life, autonomy and sleep.

CANNAMS: an unprecedented study for the treatment of multiple sclerosis

Launched in March 2021, the aim of the medical cannabis experiment in France is to assess the feasibility of making medical cannabis available in a secure and rigorous framework for serious pathologies with therapeutic impasses, such as certain forms of chronic pain, neurological diseases or spasticity. While some treatments have already been granted marketing authorization internationally following previous studies, they are unfortunately not marketed in our country. The CANNAMS study marks an unprecedented step in the treatment of multiple sclerosis, with for the first time in France the allocation of resources to enable patients suffering from painful spasticity to test medical cannabis and evaluate its efficacy in this indication.

Improvement of symptoms from the first months, good overall tolerance

Among the 2,486 patients included in the national trial, 309 were followed up for painful spasticity linked to MS. They received mainly orally administered oils containing cannabinoids (CBD and THC) with ratios adapted to each clinical case. Within three months of treatment, patients reported a significant improvement in their symptoms: reduced pain, spasms, anxiety and improved quality of life. This was measured using two quality of life scales, the EQ5D (European Quality of Life 5 Dimensions) and the GIC (Global Impression of Change). These effects were maintained for up to 24 months in patients continuing treatment. 76% of patients continued treatment over time. Discontinuations (24%) were mainly due to lack of efficacy (42%), some patients not being receptive, or to side effects (38%), or restrictive (such as not being able to drive during treatment) with no predominant serious adverse effects.

"These results confirm that medical cannabis can be a very interesting option for certain multiple sclerosis patients for whom we have no therapeutic alternative, when conventional treatments are no longer sufficient. It's a well-tolerated, effective treatment, and we haven't observed any addiction or dependency effects. For these reasons, I strongly hope that access to medical cannabis can soon be generalized in France, to the benefit of both current and future patients" explains Françoise Durand-Dubief, spokesperson for FCRIN4MS, neurologist at the Pierre Wertheimer Neurological Hospital - Hospices Civils de Lyon, President of the Société Francophone de la Sclérose en Plaques, in charge of the study.

"I was diagnosed with multiple sclerosis in 2005 with spasticity as my main syndrome. I've tried many treatments but with no real relief. Even if it doesn't cure everything, medical cannabis is a real help: my stiffness has decreased, I've regained tone, better amplitude in my hand, and I sleep much better. Before, I used to wake up at night every 2 hours, whereas now it only happens once. It's simple: my quality of life has improved markedly, and I couldn't do without it" confides Jean-Luc, a patient suffering from multiple sclerosis with intractable spasticity, and included in the CANNAMS study.

A study that mobilized many French players The experiment was carried out in a number of hospitals in France. Lead physicians included:

• Dr Françoise Durand-Dubief, neurologist, Hôpital Neurologique Pierre Wertheimer - Hospices Civils de Lyon
• Pr Éric Thouvenot, head of neurology department, CHU de Nîmes
• Dr Cécile Donzé, head of the physical medicine and rehabilitation department, GHICL - Lille
• Pr Thibault Moreau, neurologist, CHU de Dijon, chairman of the medical-scientific committee of the ARSEP Foundation
• Dr Clarisse Carra-Dallière, neurologist, CHU de Montpellier
• Pr Christine Lebrun-Frenay, head of neurology, CHU de Nice
• Pr Nicolas Authier, psychiatrist and pharmacologist, CHU de Clermont-Ferrand, president of the Institut Analgésia

All are members of the FCRIN4MS network, which was asked to help analyze data in the indication of intractable painful spasticity in multiple sclerosis.