Managing IBD With Medical Marijuana: More Evidence Is Needed

More evidence to support the use of medical marijuana for the management of inflammatory bowel disease (IBD) is needed, according to the authors of a new meta-analysis.

The determination comes after the meta-analysis yielded extremely limited evidence regarding the use of marijuana or its derivatives in the management of ulcerative colitis (UC) or Crohn disease (CD) for induction of remission or response to therapy. 

“Ultimately more studies are needed to standardize the dose, frequency, potency, and route of administration of marijuana in relation to the response to therapy, induction of remission, and maintenance of remission,” the authors wrote. “Until such studies are performed, one should consider the use of marijuana for inflammatory bowel disease as experimental and with unclear benefits.”

To compare the impact of marijuana vs placebo/standard of care on the clinical response, induction of clinical remission, and maintenance of clinical remission, the researchers performed a systematic search of relevant research on PubMed, Embase, and Web of Science in June 2019. After reviewing 334 studies, the researchers found 1 trial for UC and 2 trials for CD that met eligibility.

In the UC trial, 29 patients had received marijuana treatment, and 31 patients had received placebo/standard of care. Between the 2 groups, there was no difference in failure to achieve clinical remission (relative risk [RR] 1.02, 95% confidence interval [CI] 0.76-1.37) or a response to therapy (RR 0.99, 95%CI 0.65-1.21). All of the patients in the marijuana group had experienced adverse events (RR 1.28, 95%CI 1.05-1.56).

In the CD trials, 21 patients had been treated with marijuana, and 19 patients had been treated with placebo/standard of care. The groups showed no difference in failure to achieve clinical remission (RR 0.72, 95%CI 0.47-1.12) or failure to achieve clinical response (RR 0.15, 95%CI 0.02-1.05). Adverse events were not reported per patient. 

Based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, the quality of evidence was low to very low.

“Data supporting the use of marijuana for the management of IBD are extremely limited,” the researchers wrote. “Further well-designed studies are needed before any positive conclusions regarding marijuana use can be drawn.”

—Colleen Murphy

Reference:

Desmarais A, Smiddy S, Reddy S, El-Dallal M, Erlich J, Feuerst JD. Evidence supporting the benefits of marijuana for Crohn's disease and ulcerative colitis is extremely limited: a meta-analysis of the literature. Ann Gastroenterol. 2020;33(5):495-499. doi:10.20524/aog.2020.0516