Cannabinoids for Symptom Management in Children and Adolescents with Autism Spectrum Disorder: A systematic Review and Meta-Analysis
Author(s)
Manik Chhabra, PharmD, PhD (C)1, Colleen Pawliuk, MLIS2, Edlyn Lim, MLIS3, Mê-Linh Lê, MLIS4, Holly Mansell, PharmD, PhD5, S. Rod Rassekh, MD6, Harold Siden, MD7, Tim F. Oberlander, MD7, Lauren E Kelly, MSc, PhD1;
1University of Manitoba, Department of Pharmacology and Therapeutics, Winnipeg, MB, Canada, 2BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada, Department of Pediatrics, Vancouver, BC, Canada, 3University of British Columbia, Woodward Library, Vancouver, BC, Canada, 4University of Manitoba, Neil John Maclean Health Sciences Library, Winnipeg, MB, Canada, 5University of Saskatachewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada, 6University of British Columbia, Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Faculty of Medicine, Vancouver, BC, Canada, 7University of British Columbia, Department of Pediatrics, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
1University of Manitoba, Department of Pharmacology and Therapeutics, Winnipeg, MB, Canada, 2BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada, Department of Pediatrics, Vancouver, BC, Canada, 3University of British Columbia, Woodward Library, Vancouver, BC, Canada, 4University of Manitoba, Neil John Maclean Health Sciences Library, Winnipeg, MB, Canada, 5University of Saskatachewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada, 6University of British Columbia, Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Faculty of Medicine, Vancouver, BC, Canada, 7University of British Columbia, Department of Pediatrics, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
OBJECTIVES: We aimed to systematically appraise the current evidence on the dosing, safety, and efficacy of cannabinoids used in children with ASD.
METHODS: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, and Google Scholar databases were searched. Two reviewers independently performed title, abstract, and full-text screening. Studies involving at least 1 child aged 18 years or below using pharmaceutical or phytocannabinoids for ASD-related symptom management were included. Two reviewers independently performed data extraction and quality assessment. R Studio was used for data analyses. Primary outcomes were the type of cannabinoids, dosing, and efficacy outcomes. Secondary outcomes were the incidence of withdrawal, withdrawal due to adverse events, adverse events, serious events, and specific adverse events.
RESULTS: Forty-three unique studies were identified, including 7 case reports, 3 case series, 7 cross-sectional surveys, 2 qualitative interviews, 9 observational studies, 2 treatment chart reviews, 8 single-arm trials, and 5 randomized controlled trials. Of these 43 studies, 62.7%(n=27) included children exclusively. The total number of participants in the included studies were 4330, with an average male: female percentage ratio of 80.9:18.8 and age ranging between 6 months to 86 years. Cannabidiol (CBD)-enriched cannabis herbal extract (n=25/43, dose-range 0.9-21mg/kg CBD/day, 0.1-0.8mg/kg THC/day), purified CBD (n=7/43, 3-20 mg/kg/day), cannabidivarin-enriched cannabis herbal extract (n=1/43,5-20mg/kg/day), cannabidiolic acid-enriched cannabis herbal extract (n=1/43,1.5mgCBDA/day, 0.6mgTHCA/day), dronabinol (n=3/43,0.62-20 mg/day), and undefined medical cannabis (n=7/43) were used in children with ASD. Epilepsy, sleep impairment, hyperactivity, concentration impairment, and irritability were the common symptoms managed with cannabinoids in children with ASD. The pooled prevalence of adverse events (AEs) across single-arm and observational studies was 44.8%(95% CI, 24.1-67.4;I2=94%; 9 studies) in children with ASD.
CONCLUSIONS: Cannabinoids may be beneficial in children with ASD but given heterogeneity in outcome selection and small sample sizes, these potential benefits are currently not supported by high-quality evidence.
METHODS: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, and Google Scholar databases were searched. Two reviewers independently performed title, abstract, and full-text screening. Studies involving at least 1 child aged 18 years or below using pharmaceutical or phytocannabinoids for ASD-related symptom management were included. Two reviewers independently performed data extraction and quality assessment. R Studio was used for data analyses. Primary outcomes were the type of cannabinoids, dosing, and efficacy outcomes. Secondary outcomes were the incidence of withdrawal, withdrawal due to adverse events, adverse events, serious events, and specific adverse events.
RESULTS: Forty-three unique studies were identified, including 7 case reports, 3 case series, 7 cross-sectional surveys, 2 qualitative interviews, 9 observational studies, 2 treatment chart reviews, 8 single-arm trials, and 5 randomized controlled trials. Of these 43 studies, 62.7%(n=27) included children exclusively. The total number of participants in the included studies were 4330, with an average male: female percentage ratio of 80.9:18.8 and age ranging between 6 months to 86 years. Cannabidiol (CBD)-enriched cannabis herbal extract (n=25/43, dose-range 0.9-21mg/kg CBD/day, 0.1-0.8mg/kg THC/day), purified CBD (n=7/43, 3-20 mg/kg/day), cannabidivarin-enriched cannabis herbal extract (n=1/43,5-20mg/kg/day), cannabidiolic acid-enriched cannabis herbal extract (n=1/43,1.5mgCBDA/day, 0.6mgTHCA/day), dronabinol (n=3/43,0.62-20 mg/day), and undefined medical cannabis (n=7/43) were used in children with ASD. Epilepsy, sleep impairment, hyperactivity, concentration impairment, and irritability were the common symptoms managed with cannabinoids in children with ASD. The pooled prevalence of adverse events (AEs) across single-arm and observational studies was 44.8%(95% CI, 24.1-67.4;I2=94%; 9 studies) in children with ASD.
CONCLUSIONS: Cannabinoids may be beneficial in children with ASD but given heterogeneity in outcome selection and small sample sizes, these potential benefits are currently not supported by high-quality evidence.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO70
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Neurological Disorders, SDC: Pediatrics