Przegląd najnowszych badań klinicznych dotyczących zastosowania kanabinoidów w leczeniu stwardnienia rozsianego Artykuł przeglądowy
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Opublikowane:
wrz 30, 2025
Słowa kluczowe:
kanabinoidy, stwardnienie rozsiane, tetrahydrokanabinol, kanabidiol
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Abstrakt
Kanabinoidy są jedną z opcji terapeutycznych w objawowym leczeniu stwardnienia rozsianego. Wyniki badań klinicznych wskazują, że zastosowanie preparatu zawierającego mieszaninę tetrahydrokanabinolu i kanabidiolu może przynosić umiarkowaną, lecz klinicznie istotną poprawę spastyczności u pacjentów, u których standardowe leczenie jest nieskuteczne – doprowadziło to do rejestracji tego preparatu. W opinii pacjentów przynosi on subiektywnie odczuwalną poprawę, choć duża część obiektywnych analiz nie wykazała istotnej statystycznie poprawy u badanych otrzymujących preparat z konopi w porównaniu z otrzymującymi placebo. Dane dotyczące wpływu na inne objawy, takie jak zaburzenia snu, funkcje pęcherza moczowego, czy na jakość życia pozostają niejednoznaczne i wymagają dalszych badań. Profil bezpieczeństwa preparatów kanabinoidowych dopuszczonych do obrotu oceniany jest jako akceptowalny, jednak występujące działania niepożądane, takie jak senność, zawroty głowy czy wahania nastroju, mogą ograniczać ich stosowanie u niektórych pacjentów. Aktualne dowody wspierają stosowanie kanabinoidów jako terapii alternatywnej, szczególnie w lekoopornej spastyczności, jednocześnie podkreśla się konieczność prowadzenia dalszych, bardziej zaawansowanych badań, które jednoznacznie potwierdzają ich skuteczność.
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Artykuły
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Bibliografia
1. Johnson JK, Colby A. History of Cannabis Regulation and Medicinal Therapeutics: It’s Complicated. Clin Ther. 2023; 45(6): 521-6.
2. Charitos IA, Gagliano-Candela R, Santacroce L et al. The Cannabis Spread throughout the Continents and its Therapeutic Use in History. Endocr Metab Immune Disord Drug Targets. 2021; 21(3): 407-17.
3. Bezalwar A, Patil PS, Pajai S et al. Journey of Marijuana From „Folk Tales” to „Doors of Justice”: A Comprehensive Review. Cureus. 2024; 16(3): e57190.
4. Xie Z, Mi Y, Kong L et al. Cannabis sativa: origin and history, glandular trichome development, and cannabinoid biosynthesis. Hortic Res. 2023; 10(9): uhad150.
5. Zuardi AW. History of cannabis as a medicine: a review. Braz J Psychiatry. 2006; 28(2): 153-7.
6. Walsh KB, McKinney AE, Holmes AE. Minor Cannabinoids: Biosynthesis, Molecular Pharmacology and Potential Therapeutic Uses. Front Pharmacol. 2021; 12: 777804.
7. Radwan MM, Chandra S, Gul S et al. Cannabinoids, Phenolics, Terpenes and Alkaloids of Cannabis. Molecules. 2021; 26(9): 2774.
8. Stasiłowicz A, Tomala A, Podolak I et al. Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment. Int J Mol Sci. 2021; 22(2): 778.
9. Blebea NM, Pricopie AI, Vlad RA et al. Phytocannabinoids: Exploring Pharmacological Profiles and Their Impact on Therapeutical Use. Int J Mol Sci. 2024; 25(8): 4204.
10. Finn DP, Haroutounian S, Hohmann AG et al. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies. Pain. 2021; 162(Suppl 1): S5-S25.
11. Gülck T, Møller BL. Phytocannabinoids: Origins and Biosynthesis. Trends Plant Sci. 2020; 25(10): 985-1004.
12. Lapierre É, Monthony AS, Torkamaneh D. Genomics-based taxonomy to clarify cannabis classification. Genome. 2023; 66(8): 202-11.
13. Lu HC, Mackie K. Review of the Endocannabinoid System. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; 6(6): 607-15.
14. Bonini SA, Premoli M, Tambaro S et al. Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. J Ethnopharmacol. 2018; 227: 300-15.
15. Bilbao A, Spanagel R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med. 2022; 20: 259.
16. Jardim C, Delgado-Charro MB. The Regulatory Environment Surrounding Cannabis Medicines in the EU, the USA, and Australia. Pharmaceutics. 2025; 17(5): 635.
17. MacCallum CA, Lo LA, Pistawka CA et al. Cannabis vaporisation: Understanding products, devices and risks. Drug Alcohol Rev. 2024; 43(3): 732-45.
18. Leal WE, Moscrop-Blake K. The many forms of cannabis use: Prevalence and correlates of routes of administration among nationally representative samples of U.S. adult and adolescent cannabis users. Addict Behav. 2024; 159: 108146.
19. Stella B, Baratta F, Della Pepa C et al. Cannabinoid Formulations and Delivery Systems: Current and Future Options to Treat Pain. Drugs. 2021; 81(13): 1513-57.
20. Spindle TR, Bonn-Miller MO, Vandrey R. Changing landscape of cannabis: novel products, formulations, and methods of administration. Curr Opin Psychol. 2019; 30: 98-102.
21. Filipiuc SI, Neagu AN, Uritu CM et al. The Skin and Natural Cannabinoids-Topical and Transdermal Applications. Pharmaceuticals (Basel). 2023; 16(7): 1049.
22. Klimkiewicz A. Konopie i medyczne zastosowanie kannabinoidów – praktyczne rekomendacje; Warszawa 2022: 262-74.
23. Ustawa z dnia 29 lipca 2005 r. o przeciwdziałaniu narkomanii; https://eli.gov.pl/eli/DU/2005/1485/ogl.
24. Belackova V, Petruzelka B, Cihak J et al. „The whole picture”: A review of international research on the outcomes of regulated cannabis supply. Int J Drug Policy. 2025; 142: 104796.
25. Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry. 2020; 19(2): 179-86.
26. Khoj L, Zagà V, Amram DL et al. Effects of cannabis smoking on the respiratory system: A state-of-the-art review. Respir Med. 2024; 221: 107494.
27. Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J. 2005; 50(2): 70-4.
28. Hoch E, Volkow ND, Friemel CM. Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits. Eur Arch Psychiatry Clin Neurosci. 2025; 275(2): 281-92.
29. Meier MH, Caspi A, R Knodt Am et al. Long-Term Cannabis Use and Cognitive Reserves and Hippocampal Volume in Midlife. Am J Psychiatry. 2022; 179(5): 362-74.
30. Rezkalla SH, Kloner RA. A Review of Cardiovascular Effects of Marijuana Use. J Cardiopulm Rehabil Prev. 2025; 45(1): 2-7.
31. Jeffers AM, Glantz S, Byers AL et al. Association of Cannabis Use With Cardiovascular Outcomes Among US Adults. J Am Heart Assoc. 2024; 13(5): e030178.
32. Robinson T, Fischer B, Hautala R et al. Risk thresholds for the frequency of cannabis use during pregnancy and adverse neonatal outcomes: protocol for a systematic review and dose-response meta-analysis. Syst Rev. 2024; 13(1): 307.
33. Gerede A, Stavros S, Chatzakis C et al. Cannabis Use during Pregnancy: An Update. Medicina (Kaunas). 2024; 60(10): 1691.
34. Mulligan MK, Hamre KM. Influence of prenatal cannabinoid exposure on early development and beyond. Adv Drug Alcohol Res. 2023; 3: 10981.
35. Swenson K. Cannabis for morning sickness: areas for intervention to decrease cannabis consumption during pregnancy. J Cannabis Res. 2023; 17; 5(1): 22.
36. Lo JO, Hedges JC, Girardi G. Impact of cannabinoids on pregnancy, reproductive health, and offspring outcomes. Am J Obstet Gynecol. 2022; 227(4): 571-81.
37. Urits I, Charipova K, Gress K et al. Adverse Effects of Recreational and Medical Cannabis. Psychopharmacol Bull. 2021; 51(1): 94-109.
38. Connor JP, Stjepanović D, Le Foll B et al. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 2021; 7(1): 16.
39. Connor JP, Stjepanović D, Budney AJ et al. Clinical management of cannabis withdrawal. Addiction. 2022; 117(7): 2075-95.
40. Bahji A, Meyyappan AC, Hawken ER et al. Pharmacotherapies for cannabis use disorder: A systematic review and network meta-analysis. Int J Drug Policy. 2021; 97: 103295.
41. Sturm D, Gurevitz SL, Turner A. Multiple sclerosis: a review of the disease and treatment options. Consult Pharm. 2014; 29(7): 469-79.
42. Lorenzut S, Negro ID, Pauletto G et al. Exploring the Pathophysiology, Diagnosis, and Treatment Options of Multiple Sclerosis. J Integr Neurosci. 2025; 24(1): 25081.
43. Olejnik P, Roszkowska Z, Adamus S et al. Multiple sclerosis: a narrative overview of current pharmacotherapies and emerging treatment prospects. Pharmacol Rep. 2024; 76(5): 926-43.
44. Haki M, Al-Biati HA, Al-Tameemi ZS et al. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore). 2024; 103(8): e37297.
45. Ward M, Goldman MD. Epidemiology and Pathophysiology of Multiple Sclerosis. Continuum (Minneap Minn). 2022; 28(4): 988-1005.
46. Ghasemi N, Razavi S, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell J. 2017; 19(1): 1-10.
47. Otero-Romero S, Sastre-Garriga J, Comi G et al. Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Multiple Sclerosis Journal. 2016; 22(11): 1386-96.
48. Halabchi F, Alizadeh Z, Sahraian MA et al. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol. 2017; 17(1): 185.
49. Gold R, Oreja-Guevara C. Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines. Expert Rev Neurother. 2013; 13(12 Suppl): 55-9.
50. Hugos CL, Cameron MH. Assessment and Measurement of Spasticity in MS: State of the Evidence. Curr Neurol Neurosci Rep. 2019; 19(10): 79.
51. Farrar JT, Troxel AB, Stott C et al. 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(5): 974-85.
52. Zakrzewska-Pniewska B, Adamczyk-Sowa M, Brola W et al. Leczenie i postępowanie objawowe w stwardnieniu rozsianym Rekomendacje Sekcji SM i Neuroimmunologii Polskiego Towarzystwa Neurologicznego. Polski Przegląd Neurologiczny. 2019; 15(14): 191-217.
53. Zajicek JP, Hobart JC, Slade A et al. Multiple sclerosis and extract of cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry. 2012; 83(11): 1125-32.
54. Zajicek JP, Sanders HP, Wright D et al. Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up. J Neurol Neurosurg Psychiatry. 2005; 76(12): 1664-9.
55. Filippini G, Minozzi S, Borrelli F et al. Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis. Cochrane Database of Systematic Reviews. 2022; 5: CD013444.
56. AlHabil Y, Saadeddin L, Ishkirat H et al. Assessing the Role of Cannabis in Managing Spasticity in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Clin Ther. 2025: S0149-2918(25)00246-2.
57. Azadvari M, Pourshams M, Guitynavard F et al. Cannabinoids for spasticity in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler J Exp Transl Clin. 2024; 10(4): 20552173241282379.
58. Dykukha I, Essner U, Schreiber H et al. Effects of Sativex® on cognitive function in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2022; 68: 104173.
59. Patti F, Chisari C, Solaro C et al. Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study. Neurol Sci. 2020; 41: 2905-913.
60. D’hooghe M, Willekens B, Delvaux V et al. Sativex® (nabiximols) cannabinoid oromucosal spray in patients with resistant multiple sclerosis spasticity: the Belgian experience. BMC Neurol. 2021; 21: 227.
61. Bethoux FA, Farrell R, Checketts D et al. A randomized, double-blind, placebo-controlled trial to evaluate the effect of nabiximols oromucosal spray on clinical measures of spasticity in patients with multiple sclerosis. Mult Scler Relat Disord. 2024; 89: 105740.
62. De Blasiis P, Siani MF, Fullin A et al. Short and long term effects of Nabiximols on balance and walking assessed by 3D-gait analysis in people with Multiple Sclerosis and spasticity. Mult Scler Relat Disord. 2021; 51: 102805.
63. Haupts MR, Essner U, Mäurer M. Patient-reported benefits from nabiximols treatment in multiple sclerosis-related spasticity exceed conventional measures. Neurodegener Dis Manag. 2024; 14(1): 11-20.
64. Pau M, Porta M, Spinicci G et al. Change in upper limb function in people with multiple sclerosis treated with nabiximols: a quantitative kinematic pilot study. Neurol Sci. 2023; 44(2): 685-91.
65. Sartori A, Dinoto A, Stragapede L et al. Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience. Neurol Sci. 2021; 42: 5037-43.
66. Chisari CG, Solaro C, Annunziata P et al. Nabiximols discontinuation rate in a large population of patients with multiple sclerosis: a 18-month multicentre study. J Neurol Neurosurg Psychiatry. 2020; 91(9): 914-20.
67. Gustavsen S, Søndergaard H, Linnet K et al. Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis. Mult Scler Relat Disord. 2021; 48: 102708.
68. Patti F, Chisari CG, Fernández Ó et al. A real-world evidence study of nabiximols in multiple sclerosis patients with resistant spasticity: Analysis in relation to the newly described ’spasticity-plus syndrome’. Eur J Neurol. 2022; 29(9): 2744-53.
69. Stavrogianni K, Kitsos DK, Giannopapas V et al. Evaluating Vaporized Cannabinoid Therapy in Multiple Sclerosis: Findings from a Prospective Single- Center Clinical Study. J Clin Med. 2025; 14(6): 2121.
2. Charitos IA, Gagliano-Candela R, Santacroce L et al. The Cannabis Spread throughout the Continents and its Therapeutic Use in History. Endocr Metab Immune Disord Drug Targets. 2021; 21(3): 407-17.
3. Bezalwar A, Patil PS, Pajai S et al. Journey of Marijuana From „Folk Tales” to „Doors of Justice”: A Comprehensive Review. Cureus. 2024; 16(3): e57190.
4. Xie Z, Mi Y, Kong L et al. Cannabis sativa: origin and history, glandular trichome development, and cannabinoid biosynthesis. Hortic Res. 2023; 10(9): uhad150.
5. Zuardi AW. History of cannabis as a medicine: a review. Braz J Psychiatry. 2006; 28(2): 153-7.
6. Walsh KB, McKinney AE, Holmes AE. Minor Cannabinoids: Biosynthesis, Molecular Pharmacology and Potential Therapeutic Uses. Front Pharmacol. 2021; 12: 777804.
7. Radwan MM, Chandra S, Gul S et al. Cannabinoids, Phenolics, Terpenes and Alkaloids of Cannabis. Molecules. 2021; 26(9): 2774.
8. Stasiłowicz A, Tomala A, Podolak I et al. Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment. Int J Mol Sci. 2021; 22(2): 778.
9. Blebea NM, Pricopie AI, Vlad RA et al. Phytocannabinoids: Exploring Pharmacological Profiles and Their Impact on Therapeutical Use. Int J Mol Sci. 2024; 25(8): 4204.
10. Finn DP, Haroutounian S, Hohmann AG et al. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies. Pain. 2021; 162(Suppl 1): S5-S25.
11. Gülck T, Møller BL. Phytocannabinoids: Origins and Biosynthesis. Trends Plant Sci. 2020; 25(10): 985-1004.
12. Lapierre É, Monthony AS, Torkamaneh D. Genomics-based taxonomy to clarify cannabis classification. Genome. 2023; 66(8): 202-11.
13. Lu HC, Mackie K. Review of the Endocannabinoid System. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; 6(6): 607-15.
14. Bonini SA, Premoli M, Tambaro S et al. Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. J Ethnopharmacol. 2018; 227: 300-15.
15. Bilbao A, Spanagel R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med. 2022; 20: 259.
16. Jardim C, Delgado-Charro MB. The Regulatory Environment Surrounding Cannabis Medicines in the EU, the USA, and Australia. Pharmaceutics. 2025; 17(5): 635.
17. MacCallum CA, Lo LA, Pistawka CA et al. Cannabis vaporisation: Understanding products, devices and risks. Drug Alcohol Rev. 2024; 43(3): 732-45.
18. Leal WE, Moscrop-Blake K. The many forms of cannabis use: Prevalence and correlates of routes of administration among nationally representative samples of U.S. adult and adolescent cannabis users. Addict Behav. 2024; 159: 108146.
19. Stella B, Baratta F, Della Pepa C et al. Cannabinoid Formulations and Delivery Systems: Current and Future Options to Treat Pain. Drugs. 2021; 81(13): 1513-57.
20. Spindle TR, Bonn-Miller MO, Vandrey R. Changing landscape of cannabis: novel products, formulations, and methods of administration. Curr Opin Psychol. 2019; 30: 98-102.
21. Filipiuc SI, Neagu AN, Uritu CM et al. The Skin and Natural Cannabinoids-Topical and Transdermal Applications. Pharmaceuticals (Basel). 2023; 16(7): 1049.
22. Klimkiewicz A. Konopie i medyczne zastosowanie kannabinoidów – praktyczne rekomendacje; Warszawa 2022: 262-74.
23. Ustawa z dnia 29 lipca 2005 r. o przeciwdziałaniu narkomanii; https://eli.gov.pl/eli/DU/2005/1485/ogl.
24. Belackova V, Petruzelka B, Cihak J et al. „The whole picture”: A review of international research on the outcomes of regulated cannabis supply. Int J Drug Policy. 2025; 142: 104796.
25. Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry. 2020; 19(2): 179-86.
26. Khoj L, Zagà V, Amram DL et al. Effects of cannabis smoking on the respiratory system: A state-of-the-art review. Respir Med. 2024; 221: 107494.
27. Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J. 2005; 50(2): 70-4.
28. Hoch E, Volkow ND, Friemel CM. Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits. Eur Arch Psychiatry Clin Neurosci. 2025; 275(2): 281-92.
29. Meier MH, Caspi A, R Knodt Am et al. Long-Term Cannabis Use and Cognitive Reserves and Hippocampal Volume in Midlife. Am J Psychiatry. 2022; 179(5): 362-74.
30. Rezkalla SH, Kloner RA. A Review of Cardiovascular Effects of Marijuana Use. J Cardiopulm Rehabil Prev. 2025; 45(1): 2-7.
31. Jeffers AM, Glantz S, Byers AL et al. Association of Cannabis Use With Cardiovascular Outcomes Among US Adults. J Am Heart Assoc. 2024; 13(5): e030178.
32. Robinson T, Fischer B, Hautala R et al. Risk thresholds for the frequency of cannabis use during pregnancy and adverse neonatal outcomes: protocol for a systematic review and dose-response meta-analysis. Syst Rev. 2024; 13(1): 307.
33. Gerede A, Stavros S, Chatzakis C et al. Cannabis Use during Pregnancy: An Update. Medicina (Kaunas). 2024; 60(10): 1691.
34. Mulligan MK, Hamre KM. Influence of prenatal cannabinoid exposure on early development and beyond. Adv Drug Alcohol Res. 2023; 3: 10981.
35. Swenson K. Cannabis for morning sickness: areas for intervention to decrease cannabis consumption during pregnancy. J Cannabis Res. 2023; 17; 5(1): 22.
36. Lo JO, Hedges JC, Girardi G. Impact of cannabinoids on pregnancy, reproductive health, and offspring outcomes. Am J Obstet Gynecol. 2022; 227(4): 571-81.
37. Urits I, Charipova K, Gress K et al. Adverse Effects of Recreational and Medical Cannabis. Psychopharmacol Bull. 2021; 51(1): 94-109.
38. Connor JP, Stjepanović D, Le Foll B et al. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 2021; 7(1): 16.
39. Connor JP, Stjepanović D, Budney AJ et al. Clinical management of cannabis withdrawal. Addiction. 2022; 117(7): 2075-95.
40. Bahji A, Meyyappan AC, Hawken ER et al. Pharmacotherapies for cannabis use disorder: A systematic review and network meta-analysis. Int J Drug Policy. 2021; 97: 103295.
41. Sturm D, Gurevitz SL, Turner A. Multiple sclerosis: a review of the disease and treatment options. Consult Pharm. 2014; 29(7): 469-79.
42. Lorenzut S, Negro ID, Pauletto G et al. Exploring the Pathophysiology, Diagnosis, and Treatment Options of Multiple Sclerosis. J Integr Neurosci. 2025; 24(1): 25081.
43. Olejnik P, Roszkowska Z, Adamus S et al. Multiple sclerosis: a narrative overview of current pharmacotherapies and emerging treatment prospects. Pharmacol Rep. 2024; 76(5): 926-43.
44. Haki M, Al-Biati HA, Al-Tameemi ZS et al. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore). 2024; 103(8): e37297.
45. Ward M, Goldman MD. Epidemiology and Pathophysiology of Multiple Sclerosis. Continuum (Minneap Minn). 2022; 28(4): 988-1005.
46. Ghasemi N, Razavi S, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell J. 2017; 19(1): 1-10.
47. Otero-Romero S, Sastre-Garriga J, Comi G et al. Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Multiple Sclerosis Journal. 2016; 22(11): 1386-96.
48. Halabchi F, Alizadeh Z, Sahraian MA et al. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurol. 2017; 17(1): 185.
49. Gold R, Oreja-Guevara C. Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines. Expert Rev Neurother. 2013; 13(12 Suppl): 55-9.
50. Hugos CL, Cameron MH. Assessment and Measurement of Spasticity in MS: State of the Evidence. Curr Neurol Neurosci Rep. 2019; 19(10): 79.
51. Farrar JT, Troxel AB, Stott C et al. 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(5): 974-85.
52. Zakrzewska-Pniewska B, Adamczyk-Sowa M, Brola W et al. Leczenie i postępowanie objawowe w stwardnieniu rozsianym Rekomendacje Sekcji SM i Neuroimmunologii Polskiego Towarzystwa Neurologicznego. Polski Przegląd Neurologiczny. 2019; 15(14): 191-217.
53. Zajicek JP, Hobart JC, Slade A et al. Multiple sclerosis and extract of cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry. 2012; 83(11): 1125-32.
54. Zajicek JP, Sanders HP, Wright D et al. Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up. J Neurol Neurosurg Psychiatry. 2005; 76(12): 1664-9.
55. Filippini G, Minozzi S, Borrelli F et al. Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis. Cochrane Database of Systematic Reviews. 2022; 5: CD013444.
56. AlHabil Y, Saadeddin L, Ishkirat H et al. Assessing the Role of Cannabis in Managing Spasticity in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Clin Ther. 2025: S0149-2918(25)00246-2.
57. Azadvari M, Pourshams M, Guitynavard F et al. Cannabinoids for spasticity in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler J Exp Transl Clin. 2024; 10(4): 20552173241282379.
58. Dykukha I, Essner U, Schreiber H et al. Effects of Sativex® on cognitive function in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2022; 68: 104173.
59. Patti F, Chisari C, Solaro C et al. Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study. Neurol Sci. 2020; 41: 2905-913.
60. D’hooghe M, Willekens B, Delvaux V et al. Sativex® (nabiximols) cannabinoid oromucosal spray in patients with resistant multiple sclerosis spasticity: the Belgian experience. BMC Neurol. 2021; 21: 227.
61. Bethoux FA, Farrell R, Checketts D et al. A randomized, double-blind, placebo-controlled trial to evaluate the effect of nabiximols oromucosal spray on clinical measures of spasticity in patients with multiple sclerosis. Mult Scler Relat Disord. 2024; 89: 105740.
62. De Blasiis P, Siani MF, Fullin A et al. Short and long term effects of Nabiximols on balance and walking assessed by 3D-gait analysis in people with Multiple Sclerosis and spasticity. Mult Scler Relat Disord. 2021; 51: 102805.
63. Haupts MR, Essner U, Mäurer M. Patient-reported benefits from nabiximols treatment in multiple sclerosis-related spasticity exceed conventional measures. Neurodegener Dis Manag. 2024; 14(1): 11-20.
64. Pau M, Porta M, Spinicci G et al. Change in upper limb function in people with multiple sclerosis treated with nabiximols: a quantitative kinematic pilot study. Neurol Sci. 2023; 44(2): 685-91.
65. Sartori A, Dinoto A, Stragapede L et al. Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience. Neurol Sci. 2021; 42: 5037-43.
66. Chisari CG, Solaro C, Annunziata P et al. Nabiximols discontinuation rate in a large population of patients with multiple sclerosis: a 18-month multicentre study. J Neurol Neurosurg Psychiatry. 2020; 91(9): 914-20.
67. Gustavsen S, Søndergaard H, Linnet K et al. Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis. Mult Scler Relat Disord. 2021; 48: 102708.
68. Patti F, Chisari CG, Fernández Ó et al. A real-world evidence study of nabiximols in multiple sclerosis patients with resistant spasticity: Analysis in relation to the newly described ’spasticity-plus syndrome’. Eur J Neurol. 2022; 29(9): 2744-53.
69. Stavrogianni K, Kitsos DK, Giannopapas V et al. Evaluating Vaporized Cannabinoid Therapy in Multiple Sclerosis: Findings from a Prospective Single- Center Clinical Study. J Clin Med. 2025; 14(6): 2121.