Medical Cannabis in the Treatment of Non-motor and Motor Symptoms in Parkinson’s Disease: A Systematic Review and Meta-analysis
Giovanna Salema Pascual1, Leonardo Pipek2, Pedro Henrique Reginato3, Jacy Bezerra Parmera2
1University of Bologna, 2Hospital das Clínicas da Faculdade de Medicina de São Paulo, 3Universidade Federal do Paraná
Objective:
To evaluate the efficacy and safety of medical cannabis for non-motor or motor symptoms of Parkinson’s disease.
Background:
Parkinson’s disease (PD) is associated with progressively impairing symptoms that lead to disability and to a decline in patients' quality of life and independence in daily activities.
Design/Methods:
We searched PubMed, Embase, and Web of Science for studies comparing extracts of cannabidiol (CBD) or tetrahydrocannabinol (THC) with placebo. The outcomes evaluated included overall assessments of PD (PDQ-39 and total UPDRS scores) as well as specific assessments of both non-motor symptoms (pain, cognition, sleep, anxiety and depression) and motor symptoms (UPDRS-III). Statistical analyses were performed using RStudio 2024.12.0+467. Heterogeneity was assessed using I2, and pooled estimates were calculated using a random-effects model.
Results:
We included 719 patients from 10 randomized controlled trials. CBD and THC extracts were administered as either oil or capsule to 455 patients, with a mean age of 63 years, of whom 55.16% were male. Our study showed no show statistically significant difference between groups for overall PD burden – PDQ-39 (MD=0.71 [-1.84;3.27]; p=0.58) and total UPDRS (MD=1.42 [-1.43;4.27]; p=0.33). Furthermore, treatment with cannabis did not improve pain (SMD=0.01 [-0.23;0.25]; p=0.96), cognition (MD=0.57 [-0.24;1.39]; p=0.17), sleep (SMD=0.11 [-0.17;0.40]; p=0.44), and depression (SMD=0.09 [-0.19;0.37]; p=0.54); while placebo showed a significantly greater effect than cannabis for anxiety (SMD=0.26 [0.03;0.49]; p=0.024). Additionally, there was no significant difference between groups for motor outcome – UPDRS-III (MD=-1.24 [-3.91;1.43] p=0.36).
Conclusions:
These findings suggest that the use of medical cannabis was not associated with statistically significant benefits for motor or non-motor symptoms in patients with Parkinson’s disease.
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