Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review
Tramèr et al.·BMJ
MixedGRADEHigh604 citations
Samplek = 30 Studien n = 1.366 Pat.
Duration24 hours follow up
ControlPlacebo or conventional antiemetics
EndpointComplete control of…
Blindingdoppelblind
DesignSystematische Review + Meta-Analyse
Cannabinoidthc
Routeoral
”Key finding
Cannabinoids were more effective than standard antiemetics against chemotherapy-induced nausea and vomiting, but showed considerable side effects (dizziness, dysphoria, hallucinations, paranoia) and higher discontinuation rates.
Summary
Systematic review of k=30 RCTs (n=1.366) on cannabinoids in chemotherapy-induced nausea. Cannabinoids (nabilone, dronabinol, levonantradol oral/i.m.) vs. conventional antiemetics (prochlorperazine, metoclopramide, among others): RR=1.38 (95% CI 1.18-1.62, NNT=6) for complete control of nausea; RR=1.28 (1.08-1.51, NNT=8) for complete control of vomiting. Patient preference for cannabinoids: RR=2.39 (2.05-2.78, NNT=3). More frequent side effects: dizziness NNT=3, dysphoria NNT=8, hallucinations NNT=17, paranoia NNT=20, hypotension NNT=7. Discontinuation due to side effects: RR=4.67 (3.07-7.09, NNT=11).
P
PopulationPatients with chemotherapy-induced nausea and vomiting, pooled n=1366
ControlPlacebo or conventional antiemetics (prochlorperazine, metoclopramide, chlorpromazine, among others)
O
OutcomeCannabinoids more effective than conventional antiemetics: RR 1,38 (95%-CI 1,18–1,62), NNT 6 for complete control of nausea; RR 1,28 (1,08–1,51), NNT 8 for complete control of vomiting; more frequent side effects (dizziness, dysphoria, hallucinations, paranoia)
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Objective: To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy.
Design: Systematic review.
Data Sources: Systematic search (Medline, Embase, Cochrane library, bibliographies), any language, to August 2000.
Studies: 30 randomised comparisons of cannabis with placebo or antiemetics from which dichotomous data on efficacy and harm were available (1366 patients). Oral nabilone, oral dronabinol (tetrahydrocannabinol), and intramuscular levonantradol were tested. No cannabis was smoked. Follow up lasted 24 hours.
Results: Cannabinoids were more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride: relative risk 1.38 (95% confidence interval 1.18 to 1.62), number needed to treat 6 for complete control of nausea; 1.28 (1.08 to 1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles: 2.39 (2.05 to 2.78), NNT 3. Some potentially beneficial side effects occurred more often with cannabinoids: "high" 10.6 (6.86 to 16.5), NNT 3; sedation or drowsiness 1.66 (1.46 to 1.89), NNT 5; euphoria 12.5 (3.00 to 52.1), NNT 7. Harmful side effects also occurred more often with cannabinoids: dizziness 2.97 (2.31 to 3.83), NNT 3; dysphoria or depression 8.06 (3.38 to 19.2), NNT 8; hallucinations 6.10 (2.41 to 15.4), NNT 17; paranoia 8.58 (6.38 to 11.5), NNT 20; and arterial hypotension 2.23 (1.75 to 2.83), NNT 7. Patients given cannabinoids were more likely to withdraw due to side effects 4.67 (3.07 to 7.09), NNT 11.
Conclusions: In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use.