As of April 19, 2021, we found 2 new reviews of pre-clinical studies in ALS models (Neural Regen Res 2016;11:1896-1899, J Neurochem 2019;149:284-297). These did not warrant a change in our “Pre-Clinical” TOE grade. We found a new retrospective case series in which patients taking cannabis subjectively rated its effect on their spasticity (BMC 2019;19:222)). Since this did not examine disease progression, it did not change our “Cases” grade. We found evidence of 2 new trials of cannabis products in people with ALS. Since no data are yet available from these, they did not change our “Trials” grade. Our conclusion remains unchanged.
We found 2 validated ALS Reversals whose recovery occurred in association with cannabis (as well as many other alternatives and off-label treatments). Although associations like this do not imply causality, this warrants a change in our “Cases” grade to B. Since no published trial so far has carefully examined the effects of cannabis on ALS progression our “Trials” grade should be U. We look forward to the results of on ongoing trials.
Key Information
Cannabis has biological properties including immunomodulation and effects on excitototoxicity that suggest it could be useful in ALS. Evidence from small, non-randomized, unblinded animal studies suggest that it could potentially slow ALS progression, and anecdotal reports suggest that it could ameliorate troubling ALS symptoms. Given all this, ALSUntangled supports further careful study of cannabis and cannabinoids, the active ingredients contained therein. Natural cannabis, as a single agent, provides advantages similar to a multiple drug trial given its numerous mechanisms of action. A possible next step would be a small case series of well-characterized PALS using cannabis at controlled dosages that could potentially be monitored by blood levels of cannabinoids, compared to matched controls, performed in a geographic area where it would be legal.