Duration of use of oral cannabis extract in a cohort of pediatric epilepsy patients.
Treat et al.·EpilepsiaImpact 4.1
GemischtGRADENiedrig54 Zitate
Stichproben = 119 Pat.
Dauer0,3-57 Monate
EndpunktNutzungsdauer
Verblindungn.a.
DesignRetrospektive Kohortenstudie
Cannabinoidvollspektrum
Applikationoral
”Kernaussage
Etwa ein Viertel der Patienten zeigte einen elternberichteten Anfallsrückgang >50%, jedoch brach die Mehrheit die Therapie ab; Nebenwirkungen und Dravet-Syndrom waren mit kürzerer Anwendungsdauer assoziiert.
Zusammenfassung
Retrospektive Kohorte (n=119) pädiatrischer Epilepsie-Patient:innen mit oralen Cannabis-Extrakten (OCE): 71% brachen die Therapie ab, mittlere Nutzungsdauer 11,7 Monate. 24% galten als Responder (>50% Anfallsreduktion laut Elternbericht). Wahrgenommener Anfallsnutzen war einziger Faktor für längere Therapiedauer (p<0,01); Nebenwirkungen (p=0,03) und Dravet-Syndrom-Diagnose (p=0,02) assoziierten mit früherem Abbruch.
P
PopulationKinder und Jugendliche mit refraktärer Epilepsie unter oraler Cannabis-Extrakt-Therapie, n=119
I
InterventionOraler Cannabis-Extrakt (OCE), verschiedene Produkte, Langzeitanwendung
O
Outcome71% der Patienten brachen die OCE-Therapie während des Beobachtungszeitraums ab; mittlere Anwendungsdauer 11,7 Monate; wahrgenommener Anfallsnutzen war einziger Faktor für längere Therapiedauer (p<0,01); 24% galten als Responder (>50% Anfallsreduktion laut Elternbericht); unerwünschte Ereignisse bei 19%
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Niedrig
Zweite von vier GRADE-Stufen, die Effektschätzung ist begrenzt verlässlich.
<h4>Objective</h4>Oral cannabis extracts (OCEs) are being used in the treatment of epilepsy with increasing rates in the United States following product legalization; however, no studies demonstrate clear efficacy. We evaluated the duration of use of OCEs as a measure of perceived benefit in a cohort of patients with pediatric epilepsy.<h4>Methods</h4>Retrospective chart review was performed of children and adolescents who were given OCEs for treatment of epilepsy.<h4>Results</h4>Of the 119 patients included in the analysis, 71% terminated use of their OCE product during the study period. The average length of use of OCE was 11.7 months (range 0.3-57 months). Perceived seizure benefit was the only factor associated with longer duration of treatment with OCE (p < 0.01). Relocation to Colorado was associated with perceived benefit of OCEs for seizures (65% vs. 38%, p = 0.01), but was not independently associated with longer OCE use. Factors associated with shorter use included adverse effects (p = 0.03) and a diagnosis of Dravet syndrome (p = 0.02). Twenty-four percent of patients were considered OCE responders, which was defined by a parent's report of a > 50% reduction in seizures while on this therapy. Adverse events (AEs) were reported in 19% of patients, with the most common side effects being somnolence and worsening of seizures.<h4>Significance</h4>Parental report of OCE use in refractory pediatric epilepsy suggests that some families perceive benefit from this therapy; however, discontinuation of these products is common. Duration appears to be affected by logical factors, such as perceived benefit and side effect profile. Surprisingly, families of patients with Dravet syndrome terminated use of OCEs more quickly than patients with other epilepsy syndromes. Results from this study highlight the need for rigorous clinical studies to characterize the efficacy and safety of OCEs, which can inform discussions with patients and families.