Evidence-based management of multiple sclerosis spasticity with nabiximols oromucosal spray in clinical practice: a 10-year recap

Effective symptomatic management of multiple sclerosis (MS) spasticity remains an unmet need for many patients. The second-line option nabiximols is the most widely investigated of the noninvasive antispasticity medications in this patient population. Clinical evidence accumulated with nabiximols since it was first approved in Europe in 2010 suggests that about 40% of initial responders (i.e., those with >= 20% improvement in their baseline 0-10 Numerical Rating Scale score) may expect to achieve clinically meaningful (>= 30% Numerical Rating Scale response) and durable symptomatic improvement in MS spasticity. During 10 years' routine use of nabiximols, no new safety signals have emerged. Nabiximols-associated improvement in MS spasticity-related symptoms such as pain and sleep disruption suggests a need to track possible therapeutic effects beyond muscle tone control. Plain language summary Nabiximols contains two main substances from the cannabis plant, called THC and CBD, which work together to provide symptom relief in persons with multiple sclerosis spasticity. Nabiximols is used as 'add-on' treatment in patients who are not gaining enough relief from their current antispasticity medication. Many studies of nabiximols have been carried out over the past 20 years. Overall, about 40% of patients with an early response to nabiximols might expect to achieve a noticeable improvement in spasticity that can last for months or years with continued treatment. Real-world use of nabiximols for the past 10 years shows that it is safe. Importantly, nabiximols can provide noticeable relief of other symptoms associated with spasticity such as spasms, pain and disrupted sleep.