Cannabis Use High in IBD, More Research Needed to Assess Therapeutic Effects

Issue: June 2019

SAN DIEGO — Approximately one-third of patients with inflammatory bowel disease report actively using cannabis, and 45% report using cannabis for the management of their IBD-related symptoms, according to results of a cross-sectional study presented at Digestive Disease Week.

“Animal studies have suggested that cannabinoids may have anti-inflammatory properties, [and] there have certainly been some small control trials in humans, however these have shown fairly inconsistent outcomes with respect to improvement in symptom scores and furthermore there’s been even less evidence of improvement and objective markers of inflammation,” Lillian Du, MD, of the University of Toronto and Mount Sinai Hospital in Toronto, said during her presentation.

Although the efficacy data for cannabis use are inconsistent, according to Du, recreational and medicinal use has continued to grow, with the WHO estimating approximately 147 million individuals worldwide consuming cannabis.

Previously, in 2006, a study was conducted to assess cannabis use in patients with IBD and, as Du noted during her presentation, one of the aims of the current study was to determine if those data had changed. Additionally, the researchers aimed to assess cannabis use in patients with IBD and its association with patient and disease factors.

The cross-sectional survey was conducted at a single tertiary care center – Mount Sinai Hospital in Toronto – and patients had to be an out-patient, be at least 16 years old and have radiographically and/or biopsy-confirmed IBD for more than 1 month to be included in the study.

The researchers gathered data on patients’ demographics, disease and therapy history and cannabis use history. Clinical severity (Harvey Bradshaw Index and Ulcerative Colitis Score), depression and anxiety (9-Item Patient Health Questionnaire and 7-Item General Anxiety Disorder Questionnaire) and IBD-related quality-of-life (Short Inflammatory Bowel Disease Questionnaire) were also assessed in the survey.

More than 100 (n = 131; 55.7% male) patients had CD and 75 (52% male) had ulcerative colitis.

Almost three-fourths (71%) of patients with CD reported currently receiving a biologic, while 52% of patients with UC reported currently receiving a biologic. More than half (59.5% for CD, 73.3% for UC) of the patients reported lifetime cannabis use. However, less than half (32.1% for CD, 34.7% for UC) reported current cannabis use, which was defined as use within the last 28 days.

“When we compare our results to those reported in 2006, the prevalence of active cannabis use amongst our Crohn’s disease and ulcerative colitis patients has certainly increased, and our study has found that there may be an association between cannabis use and a history of complimentary alternative medicine use in Crohn’s disease,” Du said.

In a subset analysis, there were very few characteristic differences between patients with either UC or CD who either did or did not use cannabis.

However, as Du noted, there may be an association between cannabis use and a history of anxiety in patients with UC, according to scores from the GAD-7 (P = .009).

Du acknowledged that there were some limitations to the study.

“The overall sample size is relatively large and sufficient for estimating prevalence of cannabis use in our IBD population,” Du said. “However, when we start making comparisons between subgroups, our sample size may not be sufficiently large.”

Additionally, Du noted that there was a potential for referral bias.

“The patients were seen at a tertiary referral center, so, we’re probably capturing patients with more complex and severe disease as evidenced by the fact that the majority were on biologic therapy,” she said. “[Also], given the convenient nature of our study, we are probably capturing patients that are presenting for follow-up more frequently and thus may have more complex, severe disease, and so, we may not be capturing the real-world heterogeneous IBD population in our study.”

Du concluded the session mentioning that further studies are needed to assess the potential therapeutic roles cannabis might play in IBD.

“We need larger, well-designed studies to examine both efficacy and potentially harm of cannabis in IBD patients, as well as to ascertain the optimal route of administration, formulation and dosing of cannabis in inflammatory bowel disease,” she said. – by Ryan McDonald

Reference:

Du L, et al. Abstract 108. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosure: Du reports no relevant financial disclosures.