Efficacy and safety of nabiximols (Sativex(®)) on multiple sclerosis spasticity in a real-life Italian monocentric study

Neurol Sci. 2016 Feb;37(2):235-42. doi: 10.1007/s10072-015-2392-x. Epub 2015 Oct 16.


Multiple sclerosis (MS) patients frequently suffer from limb spasticity and pain despite antispastic treatments. To investigate nabiximols efficacy and safety in a real-world monocentric Italian cohort, the following data were collected at baseline, week 4, 14 and 48: Ambulation Index (AI), 10-min walking test (10MWT), combined Modified Ashworth scale (cMAS), scores at numerical rating scale for spasticity (sNRS) and pain (pNRS). Responder status was defined as a ≥20 % reduction in sNRS after 4 weeks of treatment. 144 MS patients (123 progressive and 21 relapsing-remitting) complaining of moderate-to-severe spasticity (mean sNRS: 7.5) were included: 138 (95.8 %) completed the first month of therapy and were classified as follows-23.2 % were non-responders, 5.1 % were responders but discontinued treatment due to side effects, 71.7 % were responders with a mean 32 % reduction in sNRS (p < 0.001). In responders sNRS further decreased between 4 and 14 weeks (p = 0.03). Similarly, pNRS improvement was seen during the first month and between 4 and 14 weeks (p < 0.001 and p = 0.004, respectively). Moreover, at 4 weeks responders showed a significant (p < 0.05) improvement in cMAS, AI and 10MWT, which was maintained at 14 weeks. At 1-year follow-up, a benefit was still evident on spasticity and painful symptoms with a low drop-out rate. Confusion/ideomotor slowing, fatigue and dizziness were the most frequent side effects; no major adverse events were reported. Shorter disease duration at treatment start was associated with better response. This real-world study confirms nabiximols efficacy and safety in the treatment of MS-related spasticity and pain, which is maintained up to 48 weeks.

Keywords: Multiple sclerosis; Nabiximols; Pain; Spasticity.

MeSH terms

  • Adult
  • Cannabidiol / adverse effects*
  • Cannabidiol / therapeutic use*
  • Cohort Studies
  • Dronabinol / adverse effects*
  • Dronabinol / therapeutic use*
  • Drug Combinations
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Muscle Spasticity / drug therapy*
  • Muscle Spasticity / etiology
  • Severity of Illness Index
  • Treatment Outcome


  • Drug Combinations
  • Cannabidiol
  • Dronabinol
  • nabiximols