Systematic reviews on therapeutic efficacy and safety of Cannabis (including extracts and tinctures) for patients with multiple sclerosis, chronic neuropathic pain, dementia and Tourette syndrome, HIV/AIDS, and cancer receiving chemotherapy Laura Amato, Marina Davoli, Silvia Minozzi, Zuzana Mitrova, Elena Parmelli, Rosella Saulle, Simona Vecchi DEPARTMENT OF EPIDEMIOLOGY LAZIO REGION, ASL ROMA 1 – ROME, ITALY This document has been developed following an agreement for performance of work between the World Health Organization and ASL ROMA 1 - DEPARTMENT OF EPIDEMIOLOGY LAZIO REGION, ROME. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization. Table of Contents Table of Abbreviations....................................................................................................................................... 4 List of Tables and Figures .................................................................................................................................. 5 List of Appendices ............................................................................................................................................. 5 Abstract ............................................................................................................................................................. 6 Introduction ..................................................................................................................................................... 10 Objective ...................................................................................................................................................... 10 Clinical Question 1 ........................................................................................................................... 10 Clinical Question 2 ........................................................................................................................... 10 Clinical Question 3 ........................................................................................................................... 10 Clinical Question 4 ........................................................................................................................... 10 Clinical Question 5 ........................................................................................................................... 11 Methods .......................................................................................................................................................... 11 Search methods ........................................................................................................................................... 11 Criteria for considering studies for this review ........................................................................................... 11 Selection and Data collection ...................................................................................................................... 13 Assessment of Risk of Bias ........................................................................................................................... 13 Data analysis and synthesis ......................................................................................................................... 13 Results ......................................................................................................................................................... 15 Screening ..................................................................................................................................................... 16 Eligibility ...................................................................................................................................................... 16 Included ....................................................................................................................................................... 16 Identification ............................................................................................................................................... 16 Clinical Question 1 ........................................................................................................................................... 18 Background .................................................................................................................................................. 18 Results ......................................................................................................................................................... 19 Types of interventions ............................................................................................................................. 19 Type of comparisons................................................................................................................................ 19 Risk of bias in included studies ................................................................................................................ 19 Effects of Intervention ............................................................................................................................. 19 Narrative results ...................................................................................................................................... 21 Clinical Question 2 ........................................................................................................................................... 22 Background .................................................................................................................................................. 22 1 Results ......................................................................................................................................................... 23 Types of interventions ............................................................................................................................. 23 Type of comparisons................................................................................................................................ 23 Risk of bias in included studies ................................................................................................................ 23 Effects of interventions ........................................................................................................................... 23 Narrative results ...................................................................................................................................... 27 Clinical Question 3 ........................................................................................................................................... 27 Background .................................................................................................................................................. 27 Results ......................................................................................................................................................... 27 Risk of bias in included studies ................................................................................................................ 28 Effects of interventions ........................................................................................................................... 28 Clinical Question 4 ........................................................................................................................................... 29 Background .................................................................................................................................................. 29 Results ......................................................................................................................................................... 29 Clinical Question 5 ........................................................................................................................................... 29 Background .................................................................................................................................................. 29 Results ......................................................................................................................................................... 30 Types of interventions ............................................................................................................................. 30 Type of comparisons................................................................................................................................ 30 Risk of bias in included studies ................................................................................................................ 30 Effects of interventions ........................................................................................................................... 31 Comparison 1. Cannabis versus placebo in patients receiving chemotherapy ....................................... 31 Narrative results ...................................................................................................................................... 34 Comparison 2. Cannabis vs antiemetic drugs in patients receiving chemotherapy ............................... 35 Narrative results .....................................................................................................................................