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The use of cannabinoids in colitis: a systematic review and meta-analysis

Couch, Daniel G.; Maudslay, Henry; Doleman, Brett; Lund, Jonathan N.; O'Sullivan, Saoirse

Authors

Daniel G. Couch

Henry Maudslay

Brett Doleman

JONATHAN LUND JON.LUND@NOTTINGHAM.AC.UK
Clinical Associate Professor

Saoirse O'Sullivan



Abstract

Background: Clinical trials investigating the use of cannabinoid drugs for the treatment of intestinal inflammation are anticipated secondary to preclinical literature demonstrating efficacy in reducing inflammation.
Methods: We systematically reviewed publications on the benefit of drugs targeting the endocannabinoid system in intestinal inflammation. We collated studies examining outcomes for metaanalysis from EMBASE, MEDLINE and Pubmed until March 2017. Quality was assessed according to mSTAIR and SRYCLE score.
Results: From 2008 papers, 51 publications examining the effect of cannabinoid compounds on murine colitis, and two clinical studies were identified. 24 compounds were assessed across 71 endpoints. Cannabidiol, a phytocannabinoid, was the most investigated drug. Macroscopic colitis severity (disease activity index - DAI) and myeloperoxidase activity (MPO) were assessed throughout publications and were meta-analysed using random effects models. Cannabinoids reduced DAI in comparison with vehicle; SMD -1.36, 95% CI -1.62 to-1.09, I²=61%). FAAH inhibitor URB597 had the largest effect size (SMD-4.43, 95% CI-6.32,-2.55), followed by the synthetic drug AM1241 (SMD–3.11, 95% CI -5.01, -1.22) and the endocannabinoid anandamide (SMD-3.03, 95% CI -4.89,-1.17, I² not assessed). Cannabinoids reduced MPO in rodents compared to vehicle; SMD -1.26, 95% CI-1.54 to -0.97, I²=48.1%. Cannabigerol had the largest effect size (SMD -6.20, 95%CI-9.90, -2.50), followed by the synthetic CB₁ agonist ACEA(SMD -3.15, 95%CI-4.75, -1.55) and synthetic CB₁/₂ agonist WIN55,212-2(SMD-1.74, 95%CI-2.81, -0.67, I²=57%). We found no evidence of reporting bias. No significant difference was found between the prophylactic and therapeutic use of cannabinoid drugs.
Conclusions: There is abundant pre-clinical literature demonstrating the anti-inflammatory effects of cannabinoid drugs in inflammation of the gut. Larger randomised controlled-trials are warranted.

Citation

Couch, D. G., Maudslay, H., Doleman, B., Lund, J. N., & O'Sullivan, S. (2018). The use of cannabinoids in colitis: a systematic review and meta-analysis. Inflammatory Bowel Diseases, 24(4), 680-697. https://doi.org/10.1093/ibd/izy014

Journal Article Type Article
Acceptance Date Nov 27, 2017
Publication Date Mar 19, 2018
Deposit Date Jan 22, 2018
Publicly Available Date Mar 28, 2024
Journal Inflammatory Bowel Diseases
Print ISSN 1078-0998
Electronic ISSN 1536-4844
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 24
Issue 4
Pages 680-697
DOI https://doi.org/10.1093/ibd/izy014
Keywords cannabinoid, inflammation, gut, intestine, colitis
Public URL https://nottingham-repository.worktribe.com/output/920831
Publisher URL https://academic.oup.com/ibdjournal/article/24/4/680/4944355
Additional Information This is a non-final version of an article published in final form in Daniel G Couch, Henry Maudslay, Brett Doleman, Jonathan N Lund, Saoirse E O’Sullivan; The Use of Cannabinoids in Colitis: A Systematic Review and Meta-Analysis, Inflammatory Bowel Diseases, Volume 24, Issue 4, 19 March 2018, Pages 680–697, https://doi.org/10.1093/ibd/izy014

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