Cannabis for medical use versus opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised clinical trials.
Jeddi et al.·BMJ openImpact 2.2
GemischtGRADEHoch44 Zitate
Stichprobek = 90 Studien n = 22.028 Pat.
Dauer28 to 180 days follow-up
KontrolleOpioide oder Placebo
EndpunktVAS
Verblindungunklar
DesignMeta-Analyse
”Kernaussage
Cannabis und Opioid zeigen ähnliche kleine Schmerzverbesserungen versus Placebo; Cannabis führt zu weniger Abbrüchen durch Nebenwirkungen als Opioid, aber ähnliche Effektivität bei Schmerzlinderung und Schlafqualität.
Zusammenfassung
Network Meta-Analyse über k=90 RCTs (n=22.028) zu Cannabis vs. Opioid bei chronisch-nicht-malignem Schmerz, Follow-up 28-180 Tage. Moderate Evidenz: Opioid kleine Verbesserung Schmerz/Funktion/Schlaf vs. Placebo; Cannabis ähnliche Effekte vs. Placebo. Kein Unterschied Cannabis vs. Opioid für körperliche Funktion (WMD 0,47 auf SF-36 PCS, 95% CrI -1,97 bis 2,99) oder Schmerzlinderung (WMD 0,23 cm auf 10-cm-VAS, 95% CrI -0,06 bis 0,53); Cannabis weniger Therapieabbrüche wegen Nebenwirkungen (OR 0,55, 95% CrI 0,36-0,83).
P
PopulationErwachsene mit chronischem nicht-krebsbedingtem Schmerz, gepoolt n=22.028
OutcomeKein signifikanter Unterschied zwischen Cannabis und Opioiden bezüglich Schmerzreduktion (WMD 0,23 cm auf 10-cm-VAS, 95%-CrI −0,06 bis 0,53) oder Schlafqualität; Cannabis mit weniger therapiabbruchbedingten unerwünschten Ereignissen als Opioide (OR 0,55, 95%-CrI 0,36–0,83); moderate Evidenz für kleine Verbesserungen unter Opioiden vs. Placebo, niedrige bis moderate Evidenz für ähnliche Effekte unter Cannabis vs. Placebo
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
Qualitätsprofil
Größe★★★★★
Verblindung—
EffektstärkeGemischt
Zitate / Jahr★★★★★
Autoren
Jeddi HM, Busse JW, Sadeghirad B, Levine M, Zoratti MJ, Wang L, Noori A, Couban RJ, Tarride JE
Objective: The objective of this study is to evaluate the comparative benefits and harms of opioids and cannabis for medical use for chronic non-cancer pain.
Design: Systematic review and network meta-analysis.
Data Sources: EMBASE, MEDLINE, CINAHL, AMED, PsycINFO, PubMed, Web of Science, Cannabis-Med, Epistemonikos and the Cochrane Library (CENTRAL) from inception to March 2021.
Study Selection: Randomised trials comparing any type of cannabis for medical use or opioids, against each other or placebo, with patient follow-up >/=4 weeks.
Data Extraction And Synthesis: Paired reviewers independently extracted data. We used Bayesian random-effects network meta-analyses to summarise the evidence and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to evaluate the certainty of evidence and communicate our findings.
Results: Ninety trials involving 22 028 patients were eligible for review, among which the length of follow-up ranged from 28 to 180 days. Moderate certainty evidence showed that opioids provide small improvements in pain, physical functioning and sleep quality versus placebo; low to moderate certainty evidence supported similar effects for cannabis versus placebo. Neither was more effective than placebo for role, social or emotional functioning (all high to moderate certainty evidence). Moderate certainty evidence showed there is probably little to no difference between cannabis for medical use and opioids for physical functioning (weighted mean difference (WMD) 0.47 on the 100-point 36-item Short Form Survey physical component summary score, 95% credible interval (CrI) -1.97 to 2.99), and cannabis resulted in fewer discontinuations due to adverse events versus opioids (OR 0.55, 95% CrI 0.36 to 0.83). Low certainty evidence suggested little to no difference between cannabis and opioids for pain relief (WMD 0.23 cm on a 10 cm Visual Analogue Scale (VAS), 95% CrI -0.06 to 0.53) or sleep quality (WMD 0.49 mm on a 100 mm VAS, 95% CrI -4.72 to 5.59).
Conclusions: Cannabis for medical use may be similarly effective and result in fewer discontinuations than opioids for chronic non-cancer pain.
Prospero Registration Number: CRD42020185184.