NICE and NHS challenge Sativex and recommend more research on cannabinoids
To treat spasticity in people with multiple sclerosis an orientation project published by the National Institute for Health and Care Excellence (NICE) and the UK National Health Service (NHS) calls for more research on medical cannabis for multiple sclerosis and other diseases.
For reasons related to its profitability, NICE also recommends not prescribing Sativex as a treatment for spasticity, muscular stiffness and exaggeration of the osteotendinous reflex. spasticity being a rapid stretching of a muscle that causes its reflex contraction too easily in people with MS.
The directives of the Council on Cannabis Medicines, which will be published shortly on 4 November, follow the reclassification of these products last year to allow their use by patients whose clinical needs can not be met by approved drugs.
The evaluation focused on the clinical efficacy and cost-effectiveness of most cannabis-based products, including Sativex (by GW Pharmaceuticals). The institute also considered treatments for nausea and vomiting due to chemotherapy, chronic pain and severe treatment-resistant epilepsy.
Eight separate recommendations for further research have been formulated for all indications and products covered, which, according to NICE, reflected the total lack of evidence of clinical benefit and cost-effectiveness of these products.
Sativex is not recommended to treat spasticity due to multiple sclerosis because it has proved uneconomic, its price is too high. The guide also recommends not using other options for the same purpose outside of a clinical trial because of a "lack of clear evidence that these treatments offer benefits," says NICE in its Press release.
Because of the limited benefits compared to high costs, no cannabis products should be used to treat chronic pain other than plant cannabidiol in clinical trials, he adds. However, the synthetic cannabinoid, nabilone, can be used as an adjunct therapy for adults with nausea and vomiting caused by chemotherapy and not responding to conventional medications.
No recommendations have been made regarding the use of cannabis-based drugs in the treatment of severe resistant epilepsy, again because there is no clear evidence of their benefits.
"We recognize that some people will be disappointed that we have not been able to recommend wider use of cannabis-based medicines," said Paul Chrisp, director of the Center for Guidelines at NICEin the press release.
According to Mr. Chrisp, concerns about the lack of strong evidence of the existence of these "mostly unregistered products" were present when NICE began developing its guidelines. "After reviewing all the available evidence, it is therefore not surprising that the committee has not been able to make many positive recommendations on their use," he said.
NICE's call for more research also echoes a recent call from the National Institute of Health Research. "NICE welcomes the recent suggestion by the House of Commons Health and Social Services Committee to encourage businesses to undertake or permit research on their cannabis-based medicinal products," said Chrisp.
The United Kingdom's National Health Service (NHS) has assessed barriers to prescribing such treatments when they are safe and clinically appropriate. Having listened to families and doctors specializing in relevant areas, the NHS journal also calls for more research, especially clinical trials involving children and young adults, and clearer and more consistent guidelines. It also promotes the development of a network of clinical experts who can provide advice to prescribing healthcare professionals.
"It is clear that clinicians are very reluctant to prescribe medical cannabis," said Keith Ridge, director of the NHS Pharmaceuticals.
NHS England concluded that inadequate long-term safety and efficacy data was a key factor in clinicians' decision to prescribe or not cannabis-based medical treatments. Two clinical trials are recommended to help remedy this limitation.
"These recommendations are intended to help us develop an evidence base to understand how safe these products are and to ensure that clinicians in the UK have access to expert information and advice on how to use them. help them all over the country, "said Ms. Ridge.
Sativex and nabilone are the only cannabis-based drugs that can be used for adults in the UK.