Nabiximols oromucosal spray in patients with multiple sclerosis-related bladder dysfunction: A prospective study
Valentina Torri Clerici 1, Laura Brambilla 2, Paolo Luca Politi 3, Federica Viggiani 3, Simone Mercurio 2, Simone Tonietti 4, Marco Ronzoni 5, Sebastiano Giuseppe Crisafulli 2, Carlo Antozzi 2, Irene Tramacere 6, Chiara Redemagni 2, Paolo Confalonieri 2
- 1Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C. Besta IRCCS Foundation, Via Celoria n° 11, Milan 20133, Italy. Electronic address: valentina.torri@istituto-besta.it.
- 2Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C. Besta IRCCS Foundation, Via Celoria n° 11, Milan 20133, Italy.
- 3Urology Unit – ASST NORD Milano – E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
- 4Neurology Unit – ASST Santi Paolo e Carlo, Milan, Italy.
- 5Neurology Unit-ASST Garbagnate Milanese, Milan, Italy.
- 6Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Affiliationer
Background: Spasticity and urinary disturbances can profoundly impact the daily lives of persons with multiple sclerosis (pwMS). Cannabis has been associated with improvement in sphincteric disturbances. To our knowledge, few studies have evaluated the effect of nabiximols oromucosal spray (Sativex®) on urinary disturbances by instrumental methods.
Objectives: This longitudinal study was conducted to assess the effect of nabiximols oromucosal spray on urinary disturbances by clinical and urodynamic evaluation in pwMS.
Materials and methods: Neurological, spasticity, and quality of life (QoL) assessments were performed before (T0), and at one (T1) and six (T6) months after the start of nabiximols treatment. At these same time points, patients were assessed for urinary disturbances by the International Prostatic Symptoms Score (IPSS) and a urodynamic test evaluating maximum detrusor pressure (Pdet), bladder filling capacity (CCmax), uninhibited detrusor contractions (UDC), bladder volume at first desire (BVFD), post-void residual volume (PVR) and voluntary abdominal pressure (PA).
Results: Of 31 pwMS enrolled in the study, 25 reached T1 and 18 reached T6. Mean IPSS total score, its subscores, and IPSS QoL decreased significantly from T0 to T6 (p = 0.000), with no differences according to sex, age, MS type, disease duration and disability at baseline. Pdet improved significantly from T0 to T6 (p = 0.0171), and CCmax changed only marginally (p = 0.0494); results were similar in patient subgroups naïve to or previously exposed to urological treatment. All patients with overactive bladder showed improvement in their urodynamic assessment based on significant reduction of Pdet (p = 0.0138). In patients with mainly hypotonic bladder, mean Pdet decreased from T0 to T6 without reaching statistical significance; most urodynamic parameters showed a trend to improve. Mean numerical scale scores for MS spasticity, and for spasms, pain and tremors, decreased significantly from T0 to T6. The mean ‘physical health composite’ score of the MS Quality of Life-54 questionnaire increased significantly from T0 to T6 (p = 0.0126).
Discussion and conclusion: Our data suggest that nabiximols has an appreciable effect on ameliorating subjective perception of urinary disturbances and appears to have a positive effect on objective urodynamic parameters, particularly in patients with hyperactive bladder.