Supplementary Material for: UK Medical Cannabis Registry: An Updated Analysis of Cannabis-Based Medicinal Products for Multiple Sclerosis

Introduction Multiple sclerosis (MS) is a neurodegenerative disease presenting with a wide range of motor, sensory and psychiatric symptoms. Although nabiximols is licensed for MS-induced spasticity, cannabis-based medicinal products (CBMPs) have also displayed promising therapeutic potential for managing pain, sleep and anxiety. Therefore, further evaluation of CBMP treatment for MS is warranted. This study aimed to assess the efficacy and tolerability of CBMP treatment in patients with MS by investigating changes in MS-specific and general health-related patient-reported outcome measures and adverse events. Methods This was a prospective case series including patients with MS enrolled on the United Kingdom Medical Cannabis Registry. Changes in MS Quality of Life-54 (MSQOL-54), Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L scores were assessed from baseline up to 24 months. The prevalence and severity of all adverse events were also assessed. Results This study included 203 patients, of whom 47.29% (n=96)were female and 80.79% (n=164)had prior cannabis exposure. Improvements in the MSQOL-54 subscales: change in health, energy, health distress, pain, physical function, and physical role limitations, along with improvements in SQS and EQ-5D-5L scores, were seen at all follow-up times compared to baseline (p<0.050). A total of 278 adverse events were reported by 26 patients (12.81%). Most adverse events were mild (n=91, 32.73%) or moderate (n=138, 49.64%) in severity, with fatigue (n=27, 13.30%) and spasticity (n=17, 8.37%) being the most common. Conclusion CBMP treatment over 24 months was associated with improvements in health-related quality of life and was well-tolerated in patients with MS. Future randomised controlled trials with more representative study populations are needed to establish causal relationships.