Medical cannabis effective for cancer-related pain according to real-world study

16th May 2023

Medical cannabis for cancer-related pain in a real-world study indicates that it is safe and reduces opioid consumption.

Pain is a common symptom in patients with cancer. In fact, a previous systematic review of 52 studies, found that 59% of patients undergoing anti-cancer therapy reported experiencing pain. The World Health Organization recommends the use of NSAIDs, paracetamol or opiates, either alone or in combination for initial cancer pain management. Moreover, opiates are the preferred treatment choice for ongoing pain relief.

Emerging evidence points to an important adjunctive role of medical cannabis (MC) for cancer-related pain in those using opiates. In addition, MC use reduces both opiate and benzodiazepine use in patients with intractable pain. But the extent to which MC reduces pain medication use in those with cancer in real-world studies is still unclear.

Medical cannabis use for cancer pain

In the current study, Canadian researchers analysed registry data to determine if medical cannabis could reduce both pain and pain medicine use in cancer patients. Information on the use of MC products was collated as either cannabidiol (CBD) dominant, tetrahydrocannabinol (THC) dominant or CBD-THC balanced.

Outcome measures regarding MC use included the brief pain inventory (BPI) assessed at baseline and after three, six and nine months. The medication quantification scale (MQS) assessed medication burden over time and the morphine equivalent daily dose (MEDD), considered the opioid-sparing effect of MC use.

There were 358 cancer patients experiencing pain and with available data for analysis. Significant decreases in BPI scores occurred from baseline to month nine (5.5 vs 3.6, p <0.01). Overall pain severity scores also reduced from baseline over this time-frame (3.7 vs 2.4, p <0.01). Medical cannabis use lowered MQS in 26.2% of patients after nine months. Similarly, MEDD scores reduced in 14.3% of patients after nine months.

Only two serious adverse occurred with both considered unlikely to be caused by medical cannabis. The authors also observed better pain relief among patients using balanced CBD-THC products.

The findings led the authors to suggest that medical cannabis is a safe and effective complementary treatment for cancer-related pain. They called for randomised controlled trials to confirm these findings.

GLP-1 agonists associated with modest weight loss in real-world setting

18th February 2023

The use of glucagon-like peptide-1 (GLP-1) agonists in patients who have type 2 diabetes and are overweight is associated with a small but significant weight loss after 72 weeks, according to a retrospective analysis of electronic health records by US researchers.

It has long been recognised that obesity is an independent risk factor for cardiovascular disease. In addition, cardiovascular disease is often present in those with type 2 diabetes and presents a major cause of death among such patients.

Despite this elevated risk, lifestyle modification, in particular weight loss, has been shown to be associated with better control of diabetes and and a reduction in cardiovascular risk factors.

Clinical trials in overweight, type 2 diabetic patients have demonstrated that drugs such as semaglutide, which is one of the GLP-1 agonists, achieves superior and clinically meaningful reductions in body weight in comparison to placebo.

However, most of the weight loss clinical trials have included a lifestyle intervention to support patients but in the absence of such support, GLP-1 agonist-associated weight loss is no better than that achieved with other agents such as metformin.

In the current study, US researchers from the University of Pittsburgh, wanted to understand the degree to which GLP-1 agonists induced weight loss when used as a part of routine clinical care, i.e. in the absence of a specific behavioural weight loss intervention.

The team retrospectively examined the electronic health records of those prescribed any drugs from the GLP-1 agonist class and the subsequent weight loss after 72 weeks of therapy.

GLP-1 agonists and real-world weight loss

Outcomes were available for 2,405 participants with a mean age of 48 years (47.4% male) and of whom, 92.1% had type 2 diabetes and a mean baseline body mass index of 37.

Only eight weeks after the first dispensing of a GLP-1 agonist, the mean weight loss was 1.1% and this increased to 2.2% after 72 weeks.

However, some patients did even better. For instance, 11.2% had lost at least 5% of their body weight after eight weeks, but after 72 weeks, this proportion increased to just over a third (33.3%).

In fact, at the 72 week mark, nearly half of the entire cohort (42.7%) had lost weight, with a small proportion of patients (10.5%) managing to lose 10% or more of their body weight.

The authors concluded that the use of GLP-1 agonists prescribed at standard doses led to a modest degree of weight loss in a real-world setting and in the absence of any specific patient support.

Citation
White GE et al. Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study. Obesity (Silver Spring) 2023.

Biologic add-on therapy effective for severe asthma in real-world study

19th January 2023

Dupilumab add-on therapy in severe asthma improves the exacerbation rate and disease control according to the findings of a real-world study.

Dupilumab add-on treatment in patients with severe asthma is associated with significant improvements in the exacerbation rate, asthma control, pulmonary function and quality of life, according to the findings of a real-world study by Dutch researchers.

Severe asthma occurs when adequate control cannot be achieved by high-dose treatment with inhaled corticosteroids and additional agents (i.e. long-acting inhaled beta 2 agonists, montelukast, and/or theophylline) or by oral corticosteroid treatment, for at least six months per year.

Although it is generally considered that 5% and 10% of all asthmatic patients have severe disease, a 2015 Dutch study of asthmatic adults, found that only 3.6% qualified for a diagnosis of severe refractory asthma, representing 10.4 patients per 10,000 inhabitants.

There are currently several biological agents used to treat severe asthma including mepolizumab, benralizumab and dupilumab, with the latter agent binding to the interleukin-4-receptor-α and therefore targeting interleukin-4 and interleukin-13, both of which are key cytokines in type-2 (T2) inflammation.

Moreover, the prevalence of type 2 asthma in severe, uncontrolled disease has been found to be present in the majority (89%) of cases.

Dupilumab add-on therapy is therefore an appropriate treatment option in severe asthma and effective, as shown in randomised, controlled trials.

Nevertheless, while effective in clinical trials, some evidence has shown, especially with mepolizumab, that a large proportion of real-world mepolizumab-treated population with severe asthma, would be excluded from the clinical trial population, raising concerns over the generalisability of trial findings.

In the present study, the Dutch team set out to assess the efficacy and safety of dupilumab add-on therapy for severe asthma in a real-world cohort.

The team retrospectively examined the impact of subcutaneously administered dupilumab, either at hospital or by self-administration at home, at a dose of 200 mg every 14 days, or 300 mg in patients with other type 2 co-morbidities.

The primary endpoint was the annually exacerbation-rate (AER), whereas secondary outcomes included asthma control, pulmonary function and quality of life and the changes were assessed by comparing baseline to 12 month values.

Dupilumab add-on therapy and asthma outcomes

A total of 148 patients with a median age of 52.5 years (57% male) were included in the study, of whom 73% had allergic asthma (which includes the type 2 form).

The AER reduced from 3.00 at baseline to 1.00 at 12 months with dupilumab use (p < 0.001). In fact, after 12 months of treatment, 46% of dupilumab add-on therapy patients remained completely exacerbation-free.

Similarly, asthma-controlled-questionnaire-5 scores reduced over time, from a median of 3.00 at baseline to 1.40 after 12 months of dupilumab use (p < 0.001). Furthermore, lung function (based on FEV1) also improved, increasing from a median of 2.21 at baseline to 2.51 at 12 months (p < 0.001) in the dupilumab group.

The authors concluded that dupilumab add-on therapy in severe asthma was associated with significant improvements in the exacerbation rate, asthma control and pulmonary function, which was in line with findings observed in previous Phase III trials.

Citation
Thelen JC et al. Efficacy and safety of dupilumab as add-on therapy for patients with severe asthma: A real-world Dutch cohort study. Respir Med 2023.