A post hoc evaluation of the shift in spasticity category in individuals with multiple sclerosis-related spasticity treated with nabiximols
Clara Grazia Chisari 1, Joe Guadagno 2, Peyman Adjamian 3 4, Carlos Vila Silvan 5, Teresa Greco 6, Makarand Bagul 3 4, Francesco Patti 7
- 1Department of Medical and Surgical Sciences and Advanced Technologies ‘GF Ingrassia’, Multiple Sclerosis Center, University of Catania, Catania, Italy.
- 2Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
- 3GW Pharmaceuticals, Cambridge, UK.
- 4Jazz Pharmaceuticals, Inc., Dublin, Ireland.
- 5Almirall SA, Barcelona, Spain.
- 6Jazz Pharmaceuticals – Gentium Srl, Villa Guardia, Italy.
- 7Department of Medical and Surgical Sciences and Advanced Technologies ‘GF Ingrassia’, Multiple Sclerosis Center, University of Catania Italy.
Affiliationer
Background: Over 80% of individuals with multiple sclerosis (MS) experience MS-associated spasticity (MSS). In many European countries, after failure of first-line treatments, moderate or severe MSS can be treated with nabiximols, a cannabis-based add-on treatment.
Objective: This post hoc analysis assessed the shift of participants treated with nabiximols from higher (severe or moderate) to lower (moderate or mild/none) spasticity.
Methods: Previously published data from two randomised controlled trials (RCTs), GWSP0604 (NCT00681538) and SAVANT (EudraCT2015-004451-40), and one large real-world study (consistent with EU label), all enriched for responders, were re-analysed. Spasticity severity, measured using the 0-10 numerical rating scale (spasticity NRS), was categorised as none/mild (score <4), moderate (score ⩾4-7), or severe (score ⩾7). Results: In the two RCTs, the shift of participants with severe MSS into a lower category was significantly greater at week 12 for those receiving nabiximols versus placebo [GWSP0604: OR (95% CI), 4.4 (1.4, 14.2), p = 0.0125; SAVANT: 5.2 (1.2, 22.3), p = 0.0267]. In all three studies, over 80% of assessed patients with severe spasticity at baseline reported a shift into a lower category of spasticity after 12 weeks. Conclusions: A meaningful proportion of MSS patients treated with nabiximols shifted to a lower category of spasticity severity, typically maintained to the end of the 12-week study period.