What is cachexia – and could cannabis be a potential treatment?

Researchers at Imperial College London are presenting an overview of existing research on the effects of cannabis on cachexia at this year’s International Cannabinoid Research Society Conference in July. Lead researcher, Dr Simon Erridge, says there is potential but further research is needed.

Cachexia affects approximately nine million people globally.

The “wasting” condition causes muscle and fat loss, typically as a result of a chronic disease such as heart disease, AIDS and chronic obtrusive pulmonary disease (COPD).

Even those who are getting the right amount of nutrition will experience involuntary weight loss that can lead to a deterioration in the patient’s health.

Most people associate cachexia with cancer, with an estimated 80 percent of those with advanced cancer being diagnosed with the condition.

Current medications that are used to treat cachexia fall into several categories.

Some work by boosting appetite stimulation, encouraging the patient to eat more and, in turn, put on weight. Other medications aim to reduce the inflammation that is associated with the condition.

Although treatments exist, the number of options available are limited. Researchers at Imperial College London are now turning their attention to the potential of cannabis to treat the condition.

Scientists at the University’s Medical Cannabis Research Group have completed a systematic review and meta-analysis of the current research to gain a better understanding of what is known about the use of cannabis in treating cachexia.

Dr Simon Erridge

Led by Dr Simon Erridge, researchers found that the quality of evidence was “relatively low”, with just five studies looking at the relationship between cannabis and cachexia.

All five of the studies included a variant of THC (nabilone or dronabinol) as the active compound, which were compared against a placebo or a known active treatment for cachexia.

Imperial’s researchers were looking for improvement in appetite, weight and quality of life, but despite seeing very small improvements in appetite, the group were not able to find any “statistically significant” benefits.

However, Dr Erridge believes there is still potential for cannabis in the treatment of the condition.

As the existing research focuses purely on THC, the scientists concluded that further research is needed into the potential of CBD.

“The main conclusion we drew was that more research is needed,” Dr Erridge says.

“Secondly, there needs to be a better understanding of the appropriate regimens for this condition.

“A lot of the driving factors for [cachexia] are associated with a high inflammatory state. We understand how THC is affecting appetite stimulation, but we feel as a group that incorporating CBD, whether that be CBD on its own or alongside THC and other cannabinoids, may help elucidate different outcomes because of CBD’s known anti-inflammatory effects.”

The main driving factor behind the study, Dr Erridge says, was the preliminary evidence that suggested a molecular basis for cannabis’ effect in cachexia.

“There’s a lot of scope in terms of improving the availability of different management options for those with cachexia,” Dr Erridge continues.

“That was one of the main things that drew us to this field. We have an interest in both cancer and inflammation and the use of cannabis in those [areas]. As a condition, it covered all of those three bases and crosses that bridge quite nicely.”

In addition to his work at Imperial College London, Dr Erridge is also head of research and access at Sapphire Medical Clinics, a medical cannabis clinic offering private consultations and prescriptions to patients across the UK.

Aside from this study, Dr Erridge believes there is further potential based on patient outcomes at the clinic.

“I think there is there is potential in terms of the work that we’ve done at Sapphire with our registry,” Dr Erridge says.

“We’ve seen improvements in quality of life in patients with palliative care needs, whether that is from increased appetite or increased weight gain,”

“We are yet to dig down into it but hopefully, once we do a focused analysis of our palliative care patient outcomes, that might be something that we are able to look at from a real-world evidence point of view at Sapphire.”

The study, titled The effect of cannabis-based medicine in the treatment of cachexia: a systematic review and meta-analysis, has been submitted for publication and is awaiting peer review.

It has also been accepted for this year’s International Cannabinoid Research Society Conference in July, where Dr Erridge and his team will present their findings.

As with many areas of medical cannabis research, evidence is lacking.

The five studies included in the literature review differed significantly in terms of the medication used, the dosing regimen and the types of patients included, making it difficult for researchers to draw definite conclusions.

Following the publication of the literature review, The Medical Cannabis Research Group intends to carry out further research subject to funding.

Dr Erridge adds: “It’s been really difficult trying to get a lot of our clinical research off the ground over the past year due to Covid-19.

“Now we’ve been able to start getting them up and running, we can turn our attention to some of the other things that we want to study like cachexia.

“I think the next stages are to run randomised controlled trials studying medical cannabis regimens against both placebo and active treatment for cachexia.”