OUTCOMES | COMPARATOR | RELATIVE EFFECT (95% CI) | CERTAINTY OF EVIDENCE (GRADE) |
---|---|---|---|
Pain | |||
• ≥ 30% reduction of pain | Placebo | RR = 1.37 (1.14 to 1.64) |
|
• Change in pain scale2 | Placebo | WMD = 0.5 (0.11 to 0.80)* | Overall: Very low owing to serious risk of bias, serious inconsistency, serious indirectness, and serious imprecision |
Nausea and vomiting | |||
• Control of nausea and vomiting | Placebo | RR = 3.60 (2.55 to 5.09) | Moderate owing to serious risk of bias and serious imprecision, but magnitude had large effect |
Antiemetic | RR = 1.85 (1.18 to 2.91) | Low owing to serious risk of bias and serious inconsistency | |
• Patient preference25 | Placebo | RR = 4.82 (1.74 to 13.36) | Low owing to serious risk of bias, serious inconsistency, and serious imprecision, but magnitude had large effect† |
Antiemetic | RR = 2.76 (1.88 to 4.03) | Low owing to serious risk of bias, serious inconsistency, and serious imprecision, but magnitude had large effect† | |
Spasticity | |||
• ≥ 30% improvement in spasticity28 | Placebo | RR = 1.37 (1.07 to 1.76) | Low owing to serious risk of bias and serious publication bias |
• Change in spasticity scale2,28 | WMD = 0.31 or 0.76 | Very low owing to serious risk of bias, serious inconsistency, and serious imprecision | |
• Global impression of change | RR = 1.45 (1.08 to 1.95) | Low owing to serious risk of bias and serious inconsistency | |
Adverse events | |||
• Withdrawal owing to adverse events | Placebo | NNH = 8 to 22 | High owing to serious risk of bias and serious imprecision, but magnitude had large effect and plausible confounding had large effect |
GRADE—Grading of Recommendations Assessment, Development and Evaluation, NNH—number needed to harm, RR—risk ratio, WMD—weighted mean difference.
↵* Whiting et al2 article selected because it was more general pain rather than multiple sclerosis pain as examined in the study by Iskedjian et al.18
↵† Patient preference is inconsistent with effect on nausea and vomiting and therefore might reflect more than control of nausea and vomiting but also the euphoria or “high” received from cannabinoids.