Background: Tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex®) is an add-on therapy for moderate-to-severe multiple sclerosis (MS)-related drug-resistant spasticity (MSS). Aim: The MOVE-2 EU study collected data from everyday clinical practice concerning the effectiveness and tolerability of THC:CBD. Methods: This was an observational, prospective, multicentre, non-interventional study. Patients with resistant MSS prescribed add-on THC:CBD oromucosal spray according to approved labelling, were followed for 3 months. After 1 month, only responders (≥20% improvement in spasticity) continued treatment. The main endpoints were the evolution of MSS and associated symptoms, quality of life (QoL) and tolerability. Results: Four hundred and thirty three patients (55% female) were recruited (98% in Italy). The mean duration of MSS was 7.4 years and baclofen was used by 78.1% of participants. Three hundred and forty nine participants continued with THC:CBD oromucosal spray after 1 month, and 281 after 3 months. THC:CBD mean dosage was 6 sprays/day. MSS scores and spasticity-related symptoms (spasms, fatigue, pain, sleep quality and bladder dysfunction) were significantly improved by THC:CBD at 3 months, as were activities of daily living, and QoL (EQ-5D VAS). Adverse events, none of which were severe or serious, were reported by 10.4% of patients. Conclusions: In everyday clinical practice, THC:CBD oromucosal spray provided symptomatic relief of MSS and related troublesome symptoms.

1.
Pugliatti M, Rosati G, Carton H, et al: The epidemiology of multiple sclerosis in Europe. Eur J Neurol 2006;13:700-722.
2.
Kingwell E, Marriott JJ, Jetté N, et al: Incidence and prevalence of multiple sclerosis in Europe: a systematic review. BMC Neurol 2013;13:128.
3.
Kabus C, Hecht M, Japp G, et al: Botulinum toxin in patients with multiple sclerosis. J Neurol 2006;253(suppl 1):I26-I28.
4.
Oreja-Guevara C, González-Segura D, Vila C: Spasticity in multiple sclerosis: results of a patient survey. Int J Neurosci 2013;123:400-408.
5.
Bavikatte G, Gaber T: Approach to spasticity in general practice. Br J Med Pract 2009;2:29-34.
6.
Bensmail D, Vermersch P: [Epidemiology and clinical assessment of spasticity in multiple sclerosis]. Rev Neurol (Paris) 2012;168(suppl 3):S45-S50.
7.
Arroyo R, Vila C, Dechant KL: Impact of Sativex(®) on quality of life and activities of daily living in patients with multiple sclerosis spasticity. J Comp Eff Res 2014;3:435-444.
8.
Deutsche Gesellschaft für Neurologie: Diagnose und Therapie der Multiplen Sklerose, Version April 2014. http://www.dgn.org/leitlinien/11-leitlinien-der-dgn/2333-ll-31-2012-diagnose-und-therapie-der-multiplen-sklerose (last accessed April 2016).
9.
Shakespeare DT, Boggild M, Young C: Anti-spasticity agents for multiple sclerosis. Cochrane Database Syst Rev 2003;4:CD001332.
10.
Collin C, Davies P, Mutiboko IK, Ratcliffe S: Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. Eur J Neurol 2007;14:290-296.
11.
Collin C, Ehler E, Waberzinek G, et al: A double-blind, randomized, placebo-controlled, parallel-group study of Sativex, in subjects with symptoms of spasticity due to multiple sclerosis. Neurol Res 2010;32:451-459.
12.
Novotna A, Mares J, Ratcliffe S, et al: A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®)), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol 2011;18:1122-1131.
13.
Otero-Romero S, Sastre-Garriga J, Comi G, Hartung HP, Soelberg Sørensen P, Thompson AJ, Vermersch P, Gold R, Montalban X: Pharmacological management of spasticity in multiple sclerosis: systematic review and consensus paper. Mult Scler 2016;pii:1352458516643600.
14.
Flachenecker P, Henze T, Zettl UK: Nabiximols (THC/CBD oromucosal spray, Sativex®) in clinical practice - results of a multicentre, non-interventional study (MOVE 2) in patients with multiple sclerosis spasticity. Eur Neurol 2014;71:271-279.
15.
Trojano M, Vila C: Effectiveness and tolerability of THC/CBD oromucosal spray for multiple sclerosis spasticity in Italy: first data from a large observational study. Eur Neurol 2015;74:178-185.
16.
Sativex Oromucosal Spray: Summary of Product Characteristics (SmPC). www.medicines.org.uk/EMC/medicine/23262/SPC/Sativex+Oromucosal+Spray (last updated May 20, 2015).
17.
Farrar JT, Troxel AB, Stott C, Duncombe P, Jensen MP: Validity, reliability, and clinical importance of change in a 0-10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial. Clin Ther 2008;30:974-985.
18.
Patti F, Messina S, Solaro C, et al; SA.FE. Study Group: Efficacy and safety of cannabinoid oromucosal spray for multiple sclerosis spasticity. J Neurol Neurosurg Psychiatry 2016;87:944-951.
19.
Oreja-Guevara C, Casanova B, Ordás CM, Silván CV, Asensio D: Observational safety study of THC: CBD oromucosal spray (Sativex) in multiple sclerosis patients with spasticity. Clin Exp Pharmacol 2015;5:184.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.