CBD-rich Cannabis Sativa on core and comorbid symptoms of autism spectrum disorder: a prospective observational study

Background: Autism spectrum disorder (ASD) is a heterogeneous condition of early neurodevelopment defined by deficits in social interaction and social communication, along with repetitive patterns of behavior, interests or activities. The pathogenesis of ASD is incompletely understood, although there is general agreement that it is caused by genetic factors that modify brain development, specifically neural connectivity. This process is likely related to the role that microglia can play in controlling synaptic pruning and neuroinflammation. The Endocannabinoid System exerts control over microglial activity and therefore offers a possibility of intervention in ASD. Preclinical studies indicate that anandamide administration induces an increase in IL-10 (anti-inflammatory cytokine) production by microglia cells. Furthermore, stimulation of CB2R leads to a protective phenotype in microglia, responsible for decreased secretion of IL-1.

Objective: There is no established pharmacological treatment for the core symptoms of ASD and the psychotropic drugs used in adjuvant symptoms have limited effectiveness and expressive adverse effects. In this context, new medications are needed to control ASD-related symptoms and to promote quality of life for patients and their families.

Methods: This observational study was designed to evaluate the effects of CBD-rich Cannabis s. oil on core and comorbid symptoms of ASD over 24 weeks, simultaneously with the withdrawal of commonly used psychotropic drugs. The primary outcomes assessed the core symptoms of ASD. The secondary endpoints assessed neuropsychiatric manifestations and adverse effects. For all participants, a fixed dose of 5 drops of the cannabis oil distributed 3 times daily was started (CBD: 18.8 mg/d; THC: 1.3 mg/d).

Results: 27 participants completed the follow-up (mean±SD age, 7.2±2.9 years). There was significant (p<0.001) improvement in all core ASD symptoms: communication, sociability, and stereotyped behavior. Of the neuropsychiatric comorbidities, Avoidant Restrictive Food Intake Disorder had the greatest significant improvement at 40%. Attention Deficit Hyperactivity Disorder and Insomnia Disorder also improved significantly (p<0.05). The three most common side effects were restlessness, increased appetite and nervousness and/or aggression.

Conclusions: The present study strengthens the evidence that CBD-rich Cannabis s. oil is an effective and safe therapeutic possibility for the treatment of core and comorbid symptoms of ASD.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023