{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:47:46Z","timestamp":1782539266430,"version":"3.54.5"},"reference-count":73,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011903","name":"Gedeon Richter Talentum Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011903","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Nabiximols, a standardized extract of Cannabis sativa, has been approved as an add-on therapy for patients with moderate to severe spasticity associated with multiple sclerosis (MS). Moreover, current Italian treatment algorithms suggest that cannabis-based therapies may have further relevance in the management of MS. The aim of our systematic review and meta-analysis was to assess the effectiveness of nabiximols in relieving symptoms other than spasticity in adult MS patients. Methods: A systematic search was conducted in Web of Science, MEDLINE (via PubMed), Cochrane CENTRAL and Embase on September 10, 2025. Study selection was performed according to the predefined PROSPERO protocol (CRD42022329952). Data were combined into a common denominator and examined using a random-effects model with meta-regression expressed as mean difference (MD) and a 95% confidence interval (CI). Risk of bias was assessed using the Cochrane risk of bias instrument (RoB2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results: Of the 49 eligible articles, 25 were included in the statistical analysis (2949 patients). Significant improvements in spasm quality (MD = \u221216.87; 95% CI = (\u221229.75)\u2013(\u22123.99)), bladder function (MD = \u221216.38; 95% CI = (\u221222.18)\u2013(\u221210.58)), sleep disruption (MD = \u221215.75; 95% CI = (\u221222.02)\u2013(\u22129.49)) and gait function (timed walk MD(s) = \u22125.31; 95% CI(s) = (\u22129.88)\u2013(\u22120.74)) were observed. Time-dependency was not significant. The subject global impression of change (SGIC) improved significantly after the first month (odds ratio (OR) = 1.69; 95% CI = (1.30)\u2013(2.18)). Conclusion: Beyond spasticity, nabiximols may represent a signal of benefit for bladder function, sleep disruption, spasm quality, and gait function in MS, in line with the \u201cspasticity-plus\u201d concept. However, the evidence certainty was low to very low, and these findings should be considered exploratory.<\/jats:p>","DOI":"10.3390\/medsci14030346","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T12:37:55Z","timestamp":1782391075000},"page":"346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nabiximols in Multiple Sclerosis: Beyond Spasticity\u2014An Exploratory Systematic Review and Meta-Analysis of Symptomatic Outcomes"],"prefix":"10.3390","volume":"14","author":[{"given":"D\u00e9nes","family":"Kleiner","sequence":"first","affiliation":[{"name":"University Pharmacy, Department of Pharmacy Administration, Semmelweis University, H\u0151gyes Endre utca 7-9., 1092 Budapest, Hungary"},{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4023-6099","authenticated-orcid":false,"given":"Istv\u00e1n L\u00e1szl\u00f3","family":"Horv\u00e1th","sequence":"additional","affiliation":[{"name":"University Pharmacy, Department of Pharmacy Administration, Semmelweis University, H\u0151gyes Endre utca 7-9., 1092 Budapest, Hungary"},{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00f3ra","family":"M\u00e1tis","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Nagy","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"},{"name":"Heim P\u00e1l National Pediatric Institute, 1089 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2726-3463","authenticated-orcid":false,"given":"Dorottya","family":"Gerg\u0151","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"},{"name":"Department of Pharmacognosy, Semmelweis University, \u00dcll\u0151i \u00fat 26., 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katalin","family":"Lugosi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"},{"name":"Multiple Sclerosis Centre, Bajcsy-Zsilinszky Hospital, Magl\u00f3di \u00fat 89-91, 1106 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3612-8826","authenticated-orcid":false,"given":"G\u00e1bor","family":"Fazekas","sequence":"additional","affiliation":[{"name":"Rehabilitation Clinic, Semmelweis University, Szanat\u00f3rium utca 19, 1121 Budapest, Hungary"},{"name":"Department of Rehabilitation, University of Szeged, Tisza Lajos k\u00f6r\u00fat 97, 6722 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Feh\u00e9rv\u00e1ri","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"},{"name":"Budapest Department of Biostatistics, University of Veterinary Medicine, Istv\u00e1n utca 2., 1078 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Hegyi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"},{"name":"Institute for Translational Medicine, Medical School, University of P\u00e9cs, Szigeti \u00fat 12, 7624 P\u00e9cs, Hungary"},{"name":"Institute of Pancreatic Diseases, Semmelweis University, T\u00f6m\u0151 utca 25-29, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4088-3333","authenticated-orcid":false,"given":"Dezs\u0151","family":"Csupor","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Baross utca 22, 1085 Budapest, Hungary"},{"name":"Institute for Translational Medicine, Medical School, University of P\u00e9cs, Szigeti \u00fat 12, 7624 P\u00e9cs, Hungary"},{"name":"Institute of Clinical Pharmacy, University of Szeged, Szikra utca 8, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_2","first-page":"e24895","article-title":"Multiple Sclerosis: Therapeutic Strategies on the Horizon","volume":"14","author":"Habib","year":"2022","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.7224\/1537-2073.2015-008","article-title":"Symptomatic Management of Multiple Sclerosis-Associated Tremor Among Participants in the NARCOMS Registry","volume":"18","author":"Meador","year":"2016","journal-title":"Int. J. MS Care"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez, \u00d3., Costa-Frossard, L., Mart\u00ed nez-Gin\u00e9s, M., Montero, P., Prieto, J.M., and Rami\u00f3, L. (2020). The Broad Concept of \u201cSpasticity-Plus Syndrome\u201d in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00152"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/S1474-4422(10)70249-0","article-title":"Pharmacological management of symptoms in multiple sclerosis: Current approaches and future directions","volume":"9","author":"Thompson","year":"2010","journal-title":"Lancet Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/B978-0-444-52001-2.00023-6","article-title":"Symptomatic treatment and management of multiple sclerosis","volume":"122","author":"Toosy","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Annovazzi, P., Clerico, M., Cocco, E., Conte, A., Marfia, G.A., Salvetti, M., Tomassini, V., Totaro, R., and Centonze, D. (2026). Correction: Enhancing the endocannabinoid system to treat residual disease in relapse-free multiple sclerosis. Front. Neurol., 17.","DOI":"10.3389\/fneur.2026.1829952"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2505","DOI":"10.2174\/1570159X21666230727094431","article-title":"Nabiximols is Efficient as Add-On Treatment for Patients with Multiple Sclerosis Spasticity Refractory to Standard Treatment: A Systematic Review and Meta-Analysis of Randomised Clinical Trials","volume":"21","author":"Kleiner","year":"2023","journal-title":"Curr. Neuropharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"399","DOI":"10.2147\/JPR.S240011","article-title":"A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain","volume":"13","author":"Uberall","year":"2020","journal-title":"J. Pain Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1093\/pm\/pnab050","article-title":"Nabiximols in Chronic Neuropathic Pain: A Meta-Analysis of Randomized Placebo-Controlled Trials","volume":"22","author":"Dykukha","year":"2021","journal-title":"Pain Med."},{"key":"ref_11","first-page":"Cd014915","article-title":"Cannabis-based medicines and medical cannabis for adults with cancer pain","volume":"6","author":"Welsch","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_13","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2024, September 25). Cochrane Handbook for Systematic Reviews of Interventions. Available online: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s13643-024-02464-w","article-title":"Synthesis methods used to combine observational studies and randomised trials in published meta-analyses","volume":"13","author":"Cheurfa","year":"2024","journal-title":"Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Medica"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1177\/1352458512444498","article-title":"Assessing walking disability in multiple sclerosis","volume":"18","author":"Kieseier","year":"2012","journal-title":"Mult. Scler. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s40614-021-00284-0","article-title":"Validity and Reliability Analysis of the PlotDigitizer Software Program for Data Extraction from Single-Case Graphs","volume":"45","author":"Aydin","year":"2022","journal-title":"Perspect. Behav. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting Meta-Analyses in R with the metafor Package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Harrer, M., Cuijpers, P., Furukawa, T.A., and Ebert, D.D. (2021). Doing Meta-Analysis with R: A Hands-On Guide, Chapman & Hall\/CRC Press. [1st ed.].","DOI":"10.1201\/9781003107347"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_22","unstructured":"Harrer, M., Cuijpers, P., Furukawa, T., and Ebert, D.D. (2026, May 19). dmetar: Companion R Package For The Guide \u2018Doing Meta-Analysis in R\u2019. R package version 0.1.0. Available online: http:\/\/dmetar.protectlab.org\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1177\/0962280219889080","article-title":"Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis","volume":"29","author":"McGrath","year":"2020","journal-title":"Stat. Methods Med. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_27","unstructured":"GRADEpro GDT (2023). GRADEpro Guideline Development Tool [Software], McMaster University and Evidence Prime."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/1352458505070618","article-title":"Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis","volume":"12","author":"Wade","year":"2006","journal-title":"Mult. Scler."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/WNF.0b013e3181633497","article-title":"Psychopathological and Cognitive Effects of Therapeutic Cannabinoids in Multiple Sclerosis: A Double-Blind, Placebo Controlled, Crossover Study","volume":"32","author":"Aragona","year":"2009","journal-title":"Clin. Neuropharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1093\/pm\/pnv080","article-title":"Evaluating Sativex\u00ae in neuropathic pain management: A clinical and neurophysiological assessment in multiple sclerosis","volume":"17","author":"Russo","year":"2016","journal-title":"Pain Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s10072-017-3148-6","article-title":"THC\/CBD oromucosal spray in patients with multiple sclerosis overactive bladder: A pilot prospective study","volume":"39","author":"Maniscalco","year":"2018","journal-title":"Neurol. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2217\/nmt-2017-0055","article-title":"Effect of tetrahydrocannabinol:cannabidiol oromucosal spray on activities of daily living in multiple sclerosis patients with resistant spasticity: A retrospective, observational study","volume":"8","year":"2018","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1007\/s00415-015-7878-1","article-title":"Sativex(\u00ae) and clinical-neurophysiological measures of spasticity in progressive multiple sclerosis","volume":"262","author":"Leocani","year":"2015","journal-title":"J. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1212\/01.wnl.0000176753.45410.8b","article-title":"Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis","volume":"65","author":"Rog","year":"2005","journal-title":"Neurology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1111\/j.1468-1331.2010.03328.x","article-title":"A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex\u00ae), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis","volume":"18","author":"Novotna","year":"2011","journal-title":"Eur. J. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1002\/jcph.670","article-title":"Long-Term Data of Efficacy, Safety, and Tolerability in a Real-Life Setting of THC\/CBD Oromucosal Spray-Treated Multiple Sclerosis Patients","volume":"56","author":"Paolicelli","year":"2016","journal-title":"J. Clin. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2217\/nmt-2020-0060","article-title":"Effect of nabiximols on Goal Attainment Scale scores in patients with treatment-resistant multiple sclerosis spasticity","volume":"11","author":"Paul","year":"2021","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/ane.12660","article-title":"Upper motor neuron evaluation in multiple sclerosis patients treated with Sativex(\u00ae)","volume":"135","author":"Carotenuto","year":"2017","journal-title":"Acta Neurol. Scand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/j.1468-1331.2006.01639.x","article-title":"Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis","volume":"14","author":"Collin","year":"2007","journal-title":"Eur. J. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1179\/016164109X12590518685660","article-title":"A double-blind, randomized, placebo-controlled, parallel-group study of Sativex, in subjects with symptoms of spasticity due to multiple sclerosis","volume":"32","author":"Collin","year":"2010","journal-title":"Neurol. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"102805","DOI":"10.1016\/j.msard.2021.102805","article-title":"Short and long term effects of Nabiximols on balance and walking assessed by 3D-gait analysis in people with Multiple Sclerosis and spasticity","volume":"51","author":"Siani","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s10072-015-2392-x","article-title":"Efficacy and safety of nabiximols (Sativex\u00ae) on multiple sclerosis spasticity in a real-life Italian monocentric study","volume":"37","author":"Nuara","year":"2016","journal-title":"Neurol. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1159\/000357427","article-title":"Nabiximols (THC\/CBD Oromucosal Spray, Sativex\u00ae) in clinical practice - results of a multicenter, non-interventional study (MOVE 2) in patients with multiple sclerosis spasticity","volume":"71","author":"Flachenecker","year":"2014","journal-title":"Eur. Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1177\/1352458510378020","article-title":"Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis","volume":"16","author":"Kavia","year":"2010","journal-title":"Mult. Scler."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1007\/s00415-012-6739-4","article-title":"A double-blind, randomized, placebo-controlled, parallel-group study of THC\/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis","volume":"260","author":"Langford","year":"2013","journal-title":"J. Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/00207454.2018.1481066","article-title":"Sativex\u00ae as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: A double-blind, placebo-controlled randomised clinical trial","volume":"129","author":"Essner","year":"2019","journal-title":"Int. J. Neurosci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00415-012-6634-z","article-title":"Sativex long-term use: An open-label trial in patients with spasticity due to multiple sclerosis","volume":"260","author":"Serpell","year":"2013","journal-title":"J. Neurol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/ane.13313","article-title":"Cannabinoids in multiple sclerosis: A neurophysiological analysis","volume":"142","author":"Vecchio","year":"2020","journal-title":"Acta Neurol. Scand."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1159\/000449413","article-title":"Tetrahydrocannabinol: Cannabidiol oromucosal spray for multiple sclerosis-related resistant spasticity in daily practice","volume":"76","author":"Vermersch","year":"2016","journal-title":"Eur. Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1191\/1352458504ms1082oa","article-title":"Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients","volume":"10","author":"Wade","year":"2004","journal-title":"Mult. Scler."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"104711","DOI":"10.1016\/j.msard.2023.104711","article-title":"Nabiximols oromucosal spray in patients with multiple sclerosis-related bladder dysfunction: A prospective study","volume":"74","author":"Clerici","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2217\/nmt-2023-0040","article-title":"Patient-reported benefits from nabiximols treatment in multiple sclerosis-related spasticity exceed conventional measures","volume":"14","author":"Haupts","year":"2024","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Sacco, R., Riccitelli, G.C., Disanto, G., Bogousslavsky, J., Cavelti, A., Czell, D., Kamm, C.P., Kliesch, U., Ramseier, S.P., and Gobbi, C. (2024). Effectiveness, Safety and Patients\u2019 Satisfaction of Nabiximols (Sativex\u00ae) on Multiple Sclerosis Spasticity and Related Symptoms in a Swiss Multicenter Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102907"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e2947","DOI":"10.1002\/brb3.2947","article-title":"Non-interventional, prospective, observational study on spasticity-associated symptom control with nabiximols as add-on therapy in patients with multiple sclerosis spasticity in Austria","volume":"13","author":"Guger","year":"2023","journal-title":"Brain Behav."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"105990","DOI":"10.1016\/j.clineuro.2020.105990","article-title":"Long-term assessment of the cognitive effects of nabiximols in patients with multiple sclerosis: A pilot study","volume":"196","author":"Alessandria","year":"2020","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"460","DOI":"10.35755\/jmedassocthai.2021.03.11919","article-title":"A pilot study of the government pharmaceutical organization (gpo) cannabis extract for multiple sclerosis (ms) spasticity treatment in thailand","volume":"104","author":"Aungsumart","year":"2021","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.1007\/s00415-015-7866-5","article-title":"Walking improvements with nabiximols in patients with multiple sclerosis","volume":"262","author":"Coghe","year":"2015","journal-title":"J. Neurol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1159\/000360285","article-title":"Long-term effectiveness and safety of nabiximols (tetrahydrocannabinol\/ cannabidiol oromucosal spray) in clinical practice","volume":"72","author":"Flachenecker","year":"2014","journal-title":"Eur. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1159\/000445943","article-title":"Influence of Previous Failed Antispasticity Therapy on the Efficacy and Tolerability of THC: CBD Oromucosal Spray for Multiple Sclerosis Spasticity","volume":"75","author":"Haupts","year":"2016","journal-title":"Eur. Neurol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000444236","article-title":"Health Authorities Data Collection of THC:CBD Oromucosal Spray (L\u2019Agenzia Italiana del Farmaco Web Registry): Figures after 1.5 Years","volume":"75","author":"Patti","year":"2016","journal-title":"Eur. Neurol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1007\/s10072-020-04413-6","article-title":"Effects of THC\/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: Results from a retrospective multicenter study","volume":"41","author":"Patti","year":"2020","journal-title":"Neurol. Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"656582","DOI":"10.1155\/2015\/656582","article-title":"Sativex in the management of multiple sclerosis-related spasticity: Role of the corticospinal modulation","volume":"2015","author":"Russo","year":"2015","journal-title":"Neural. Plast."},{"key":"ref_63","first-page":"3127","article-title":"Should we care about sativex-induced neurobehavioral effects? A 6-month follow-up study","volume":"20","author":"Russo","year":"2016","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"5037","DOI":"10.1007\/s10072-021-05182-6","article-title":"Nabiximols and botulinum toxin injections for patients with multiple sclerosis: Efficacy on spasticity and spasms in a single-centre experience","volume":"42","author":"Sartori","year":"2021","journal-title":"Neurol. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2744","DOI":"10.1111\/ene.15412","article-title":"A real-world evidence study of nabiximols in multiple sclerosis patients with resistant spasticity: Analysis in relation to the newly described \u2018spasticity-plus syndrome\u2019","volume":"29","author":"Patti","year":"2022","journal-title":"Eur. J. Neurol."},{"key":"ref_66","unstructured":"(2026, June 10). Sativex Oromucosal Spray. Available online: https:\/\/www.medicines.org.uk\/emc\/product\/602\/smpc#gref."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Haddad, F., Dokmak, G., and Karaman, R. (2022). The Efficacy of Cannabis on Multiple Sclerosis-Related Symptoms. Life, 12.","DOI":"10.3390\/life12050682"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Castillo-Arellano, J., Canseco-Alba, A., Cutler, S.J., and Le\u00f3n, F. (2023). The Polypharmacological Effects of Cannabidiol. Molecules, 28.","DOI":"10.3390\/molecules28073271"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Bilbao, A., and Spanagel, R. (2022). Medical cannabinoids: A pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med., 20.","DOI":"10.1186\/s12916-022-02459-1"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1038\/s41591-021-01458-8","article-title":"Accelerating the translational medicine cycle: The Academia Europaea pilot","volume":"27","author":"Hegyi","year":"2021","journal-title":"Nat. Med."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Hegyi, P., Petersen, O.H., Holgate, S., Er\u0151ss, B., Garami, A., Szak\u00e1cs, Z., Dobszai, D., Balask\u00f3, M., Kem\u00e9ny, L., and Peng, S. (2020). Academia Europaea Position Paper on Translational Medicine: The Cycle Model for Translating Scientific Results into Community Benefits. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051532"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1177\/13524585221122207","article-title":"Polypharmacy and multiple sclerosis: A population-based study","volume":"29","author":"Chertcoff","year":"2023","journal-title":"Mult. Scler."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"20406223221108391","DOI":"10.1177\/20406223221108391","article-title":"Associated factors of potential drug-drug interactions and drug-food interactions in patients with multiple sclerosis","volume":"13","author":"Debus","year":"2022","journal-title":"Ther. Adv. Chronic. 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