Medical Cannabis and Seizure Control in Minnesota Medical Cannabis Program
Abstract number :
1.227
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2023
Submission ID :
342
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Xintian Lyu, BS – University of Minnesota
Silvia Illamola, PharmD, PhD – University of Minnesota; Ilo Leppik, MD – MINCEP Epilepsy Care; Susan Marino, PhD – University of Minnesota; Stephen Dahmer, MD – Vireo Health; Paloma Lehfeldt, MD – Vireo Health; Jeannine Conway, PharmD – University of Minnesota; Susan Park, PhD – Minnesota Department of Health; Angela Birnbaum, PhD – University of Minnesota
Rationale:
Patients with epilepsy have access to both CBD and/or Δ9-tetrahydrocannabinol (THC) products in various formulations in the Minnesota medical cannabis program. Although there are dosing recommendations for the FDA-approved product Epidiolex, there are no consistent guidelines in the state program and no data on the effects of THC in seizure patients. Patients are often dosed based on internal training of dispensing pharmacists, and patient preferences under the guidance of a certified healthcare provider. Our objective was to describe the change in seizure frequency in epilepsy patients receiving cannabis from a state program who were dispensed CBD and/or THC.
Methods:
This was a retrospective analysis of four years of data (2015 through 2019) obtained from Vireo Health, one of two manufacturers in Minnesota and the Minnesota Department of Health. Data collected included formulation and dose of products dispensed, patient weight, co-medications, and weekly seizure frequency. To be included in the analysis patients had to be certified to have epilepsy as their qualifying condition by their health care practitioner, have no other qualifying conditions, have at least four visits with a treatment duration of six months, and not have purchased products from the other manufacturer. Change in weekly seizure frequency from baseline to the last visit was calculated. Total daily dose (TDD) (mg/kg/day) dispensed on the last visit was compared by using a Kruskal-Wallis test (p=0.05), followed by a post-hoc test (p=0.05), across the different groups based on the change in weekly seizure frequency (i.e., increase, decrease, and no change).
Results:
Of 112 patients with epilepsy, 57 (50.9%) reported a decrease in weekly seizure frequency, ranging from 1 to 315 (median CBD TDD 2.2 mg/kg/day; THC TDD 0.3 mg/kg/day). Forty-five (40.2%) patients reported no change in seizures (median CBD TDD 1.1 mg/kg/day; THC TDD 0.5 mg/kg/day), including 34 (75.6%) patients who reported zero seizure frequency at both the initial and final visits. Increases in seizure frequency was observed in 10 (8.9%) patients ranging from 1 to 56 (median CBD TDD 2.0 mg/kg/day; THC TDD 0.2 mg/kg/day). In all three groups, the majority of patients (³ 73.7%) were dispensed both CBD and THC. A significant difference was found only in CBD TDD between patients experiencing a decrease and no change in seizure frequency (p = 0.019). Thirty (26.8%) patients were only taking medical cannabis and 82 (73.2%) were taking at least one to five antiseizure medications in addition to cannabis.
Conclusions:
Most epilepsy patients in this state program chose both CBD and small doses of THC. Notably, there were patients who relied solely on medical cannabis for seizure management. Given that the majority of products received by patients included THC containing formulations, more research is needed to understand the optimal cannabis use for epilepsy.
Funding:
MacMillan Innovative Epilepsy Research and Education Fund, Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota, and Vireo Health.
Clinical Epilepsy