Cannabis, cannabinoids do not induce clinical remission but improve symptoms, QOL in IBD

Cannabis and cannabinoids are not effective in inducing clinical remission or reducing inflammation in patients with inflammatory bowel disease (IBD), but they appear to significantly improve patient-reported symptoms and quality of life (QOL), suggest the results of a systematic review and meta-analysis.

The investigators searched three databases until 13 August 2019 for randomized controlled trials (RCTs) and nonrandomized studies analysing IBD patients of any age using cannabis and cannabinoids. Clinical remission was the primary outcome, and secondary ones included inflammatory biomarkers, symptom improvement, QOL scores, and hospital outcomes.

The investigators assessed risk of bias according to study type. They also performed meta-analyses using a random-effects model with subgroup analyses based on study type.

A total of 682 records were identified, of which 15 nonrandomized studies and five RCTs met the inclusion criteria. The meta-analysis of the primary outcome included 146 randomized participants (aged ≥18 years). Risk of bias was moderate.

Cannabis and cannabinoids did not induce clinical remission (risk ratio, 1.56, 95 percent confidence interval, 0.99–2.46) or affect inflammatory biomarkers. However, they improved all clinical symptoms (abdominal pain, general well-being, nausea, diarrhoea, and poor appetite) on Likert scales.

Baseline QOL scores were lower in patients using cannabis among cohort studies but significantly improved with cannabi(noid)s. Additionally, length of hospital stay was shorter and risk of parenteral nutrition was lower in patients on cannabis, but no effect was noted on other IBD complications.