Medical cannabinoids come with risks for paediatric use

Cannabinoids for medical purposes in children and adolescents have been linked to increased risk of adverse events (AEs), according to the results of a meta-analysis.

Researchers searched multiple online databases for randomized controlled trials wherein a natural or pharmaceutical cannabinoid was assessed as an intervention to manage any medical condition as compared with an active comparator or placebo in children and adolescents.

The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PRISMA-S guidelines. Random-effects model was used to pool data. The primary outcome was the incidence of withdrawals, withdrawals due to AEs, overall AEs, and serious AEs in the cannabinoid and control arms. Secondary outcomes included the incidence of specific serious AEs and AEs based on organ system involvement.

A total of 23 trials involving 3,612 participants were included (57.3 percent boys), of which 11 trials included children and adolescents only, while the other 12 trials included children, adolescents, and adults. The intervention used was purified cannabidiol in 11 trials, nabilone in four, tetrahydrocannabinol in three, cannabis herbal extract in three, and dexanabinol in two. These interventions were indicated mostly for epilepsy (39.1 percent) and chemotherapy-induced nausea and vomiting (30.4 percent).

Pooled data showed that compared with the control, cannabinoids were linked to an overall elevated risk of AEs (risk ratio [RR], 1.09, 95 percent confidence interval [CI], 1.02–1.16; I2=54 percent; 12 trials), withdrawals due to AEs (RR, 3.07, 95 percent CI, 1.73–5.43; I2=0 percent; 14 trials), and serious AEs (RR, 1.81, 95 percent CI, 1.21–2.71; I2=59 percent; 11 trials).

The risk increase associated with cannabinoid use was highest for increased serum levels of aspartate aminotransferase (RR, 5.69, 95 percent CI, 1.74–18.64; I2=0 percent; 5 trials) and alanine aminotransferase (RR, 5.67, 95 percent CI, 2.23–14.39; I2=0 percent; 6 trials), somnolence (RR, 2.28, 95 percent CI, 1.83–2.85; I2=8 percent; 14 trials), and diarrhoea (RR, 1.82, 95 percent CI, 1.30–2.54; I2=35 percent; 10 trials).