Effect of cannabinoids in mild-to-moderate cases of Crohn’s disease as compared to placebo: a systematic review and meta-analysis of randomised controlled trials

Rajesh Kumar; Shruti Singh; Vikas Maharshi

doi:10.1515/jbcpp-2023-0137

Article

Effect of cannabinoids in mild-to-moderate cases of Crohn’s disease as compared to placebo: a systematic review and meta-analysis of randomised controlled trials

Rajesh Kumar , Shruti Singh and Vikas Maharshi

Published/Copyright: February 27, 2024

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From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 35 Issue 1-2

Abstract

Introduction

In view of limited treatment options (those too may fail) for Crohn’s disease, cannabinoids have been tried as a therapeutic. However, their efficacy is not unequivocally established. This systematic review and meta-analysis was planned to pool data from randomised controlled trials (RCTs) evaluating effect of cannabinoids in Crohn’s disease with an intention to take this uncertainty away.

Content

Following literature search in Medline, EMBASE, Scopus and Google Scholar databases, RCTs assessing the effect of cannabinoids on mild-to-moderate Crohn’s disease in adults were included. Crohns’ disease activity index (CDAI), QoL (Quality of life), number participants achieving full remission and serum CRP at eight weeks of treatment were the outcomes considered for meta-analysis. Quality of studies was assessed using Cochrane’s RoB2 tool. Random effect model was applied for meta-analysis. Heterogeneity was assessed by Cochrane ‘Q’ statistics and I² test. Sensitivity analysis was performed to identify the major contributor(s) to heterogeneity and assess robustness of the results.

Summary

Risk of bias for the four included studies varied from ‘low’ to ‘some concern’. Overall effect estimate (SMD −0.92; 95 % CI −1.80, −0.03) indicated a statistically significant effect of cannabinoids as compared to control (p<0.05) on CDAI score. Effect of cannabinoids on rest of the outcome parameters was comparable to that of placebo. Magnitude of heterogeneity for different outcome parameters ranged from ‘low’ to ‘substantial’.

Outlook

Cannabinoids were superior to placebo for favourably affecting the disease severity in terms of CDAI score. However, no statistically significant difference was found between the two for improving QoL, causing full disease-remission and reducing inflammatory markers. The results must be interpreted with caution in view of relatively high heterogeneity among the studies.

Keywords: cannabinoids; Crohn’s disease; CDAI score; quality of life; CRP

Corresponding author: Dr. Vikas Maharshi, MD, DM, Department of Pharmacology, All India Institute of Medical Sciences, Patna 801507, Bihar, India, E-mail: vikas.maharshi81@gmail.com

Acknowledgements

Dr. Pramod Kumar Manjhi and Dr. Sunil Kumar assisted in registration of the protocol in the PROSPERO and developing literature search strategy.

Research ethics: Exempted from review by Institute Ethics Committee.
Informed consent: Not applicable.
Author contributions: RKM and SS conceived the project. VM designed the protocol and registered in PROSPERO. RKM and SS performed literature search. VM and RKM screened the studies and collected the data. VM and SS analysed and interpreted the data. VM drafted the manuscript. All authors read and approved the final manuscript.
Competing interests: Authors state no conflict of interest.
Research funding: Authors did not receive any funding for conducting this systematic review and meta-analysis.
Data availability: Detailed data used for analysis have been provided in supplementary material.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jbcpp-2023-0137).

Received: 2023-05-23

Accepted: 2024-01-15

Published Online: 2024-02-27

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Articles in the same Issue

https://doi.org/10.1515/jbcpp-2023-0137

Keywords for this article

cannabinoids; Crohn’s disease; CDAI score; quality of life; CRP