Could cannabidiol (CBD) be an innovative therapy to replace or decrease steroid use?
Most of us have been prescribed steroids at some point in our lives. They are often the preferred option for treating sudden episodes of inflammation, allergies or when a doctor simply does not know what to give the patient. Its immediate effects may seem miraculous. (Oh my, suddenly I have a lot of energy, my appetite came back and my mysterious rash disappeared.) But long-term steroid use comes with a number of side effects.
This is where cannabidiol (CBD) comes in, an unexpected competitor to a novel steroid replacement treatment.
THE WORLD AND STEROIDS
After its first recorded use for rheumatoid arthritis in 1948, corticosteroids (steroids) quickly became the primary immunosuppressive treatment for patients with systemic inflammatory conditions or to prevent rejection after organ transplants. Its effects were so transformative that Dr. Philip Hench, Edward Calvin Kendall and Tadeus Reichstein received the 1950 Nobel Prize in Physiology or Medicine for their discovery of the hormone cortisone and its clinical application in rheumatoid arthritis.
To please the crowd with patients, doctors used to prescribe steroids in excess. Before long, a link between steroids and increased morbidity became apparent in patients, and researchers began to find “steroid-sparing” immunosuppressive drugs. That being said, steroids are still being prescribed to this day (my dog even received a small dose for a mysterious itchy right ear), although most doctors limit this to short periods of time.
WHAT ARE STEROIDS?
It was Dr. Philip Hench who first postulated that steroids, hormones produced in the adrenal glands, alleviate pain associated with rheumatoid arthritis. With the development of corticosteroid medications like cortisone, hydrocortisone, and prednisone that mimic our endogenous steroids, a new effective way to reduce inflammation in the body was discovered.
But there is no pass to get out of jail on steroids, as their use is often accompanied by unpleasant and sometimes dangerous side effects.2 These include glaucoma, cataracts, fluid retention, high blood pressure, mood swings, increased weight, diabetes, increased risk of infection, osteoporosis, suppressed adrenal gland function, thin skin, and slower wound healing.
Consequently, doctors only prescribe steroids as a short-term solution, a measure considered relatively safe. Therefore, steroids are commonly administered to patients with sudden flare-ups in autoimmune conditions such as Crohn’s disease when short and acute immunosuppression is required.
However, not only steroid side effects can be problematic for patients. Quitting steroids, particularly when a patient has been prescribed short-term high doses or lower doses for a longer period of time, can lead to “steroid withdrawal syndrome.” 3 This occurs when the body has become dependent of ‘pharmaceutical’ steroids, their own endogenous production through the hypothalamic-pituitary-adrenal (HPA) axis to weaken and align.
Patients should not stop taking steroids suddenly. Instead, the dose should be gradually lowered down, otherwise symptoms such as weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain and headaches may appear.
STEROID REMOVAL
Eve Roginska, a London-based tattoo artist, became dangerously ill with sudden inflammatory brain disease and initially received high doses of intravenous steroids. She had been taking steroids for the past two years, but stopping was difficult.
Over time, Eve was able to gradually reduce the dose. However, every time I tried to drop below 20 mg of steroids a day, I experienced debilitating withdrawal symptoms similar to quitting drugs.
“I had terrible migraines and my pain relievers didn’t work, and sometimes this lasted all day,” Eve recalls. “I had terrible trouble sleeping. Even the sleeping pills no longer worked for me. Then all day my body would feel exhausted. A lot of fatigue and a lot of muscle pain. I was continually foggy and kept forgetting things. “
Eve was familiar with CBD oil, so she decided to see if it could ease her withdrawal symptoms. This may have been little more than a polite hunch, but it was worth it.
“Three days after starting CBD, my migraines just disappeared. After a week or two of taking it, I felt like a normal person, “she says.
Eve has now reduced her steroids to 1mg per day and hopes to completely drop them off for the summer. She has no doubts about the difference CBD has made in her recovery.
“I’d probably have to take steroids for the rest of my life if it weren’t for this oil,” she admits. “She has given me back my life.”
STEROID MEDICATIONS
Without Eve’s knowledge, around the same time that she was using CBD to stop using steroids, some Israeli scientists were actually researching CBD as a steroid-sparing treatment.
Steroid replacement agents are medications that allow a reduction in the amount of steroids taken or may even be the first-line option to suppress the immune system. Examples of steroid replacement medications include cyclophosphamide, chlorambucil, methotrexate, mycophenolate mofetil, azathioprine, cyclosporine, tacrolimus, and sirolimus. That’s not to say that taking steroid replacement agents is a walk in the park. Many of them are classified as chemotherapy drugs and come with their own unpleasant side effects.
Eve started taking methotrexate a year after her illness and during the first months she experienced diarrhea, hair loss, nausea, nail and skin problems, fatigue, abdominal swelling, interruption of her menstrual cycle, urinary tract infections and ulcers. buccal. Long-term use of immunosuppressants has also been linked to an increased risk of developing cancer in adulthood.5
It is not surprising that the search for less damaging and steroid sparing immunosuppressive agents is less harmful, and that CBD could be near the front of the pack.
Scientists know that CBD has a general anti-inflammatory / immunosuppressive effect by reducing pro-inflammatory cytokine production6 and inhibiting T-cell function.7 This probably explains why many patients with autoimmune conditions such as Crohn’s disease and rheumatoid arthritis report an improvement in symptoms when taking CBD oil.
CLINICAL TRIALS FOR CBD
Steroid replacement medications are often first developed to prevent rejection after transplants, and this holds true for CBD as well. In a small phase II clinical trial, 8 Israeli researchers wanted to see if CBD could prevent graft-versus-host disease (GVHD) in steroid-resistant patients. Often a fatal condition, GVHD occurs after a bone marrow transplant when the donated bone marrow sees the recipient’s body as foreign and attacks it.
Nine of the ten subjects responded to CBD treatment, and most of them achieved a “complete response.” While the results have not been published in a peer-reviewed journal, the team behind the study maintains that CBD “either improved the therapeutic effect of steroids or reduced doses of steroids while maintaining or improving the therapeutic effect of the steroid. Even more surprising, steroid-resistant patients also showed significant improvement under CBD treatment. “
Encouraged by these encouraging results, they have begun recruiting for phase II clinical trials for CBD as a steroid replacement treatment in Crohn’s disease9 and autoimmune hepatitis.10 In both trials, patients will gradually switch from their current treatment ( steroids or immunosuppressants) to only take 300 mg of synthetic CBD per day.
Of course, an early phase II study does not mean that CBD, synthetic or otherwise, is a proven and safe alternative to steroids or other immunosuppressive medications. Furthermore, any decision to reduce or stop steroids should always be made in conjunction with your doctor. But it does point to a possible future when CBD could be a more benign but equally effective alternative to steroids after transplants and in the treatment of autoimmune diseases.
Mary Biles, ProjectCBD.org April 7, 2020.
Translation: Alexander Gómez, Anandamida Gardens
References:
Amy K Saenger. Descubrimiento de la droga maravilla: de las vacas a la cortisona. Clinical Chemistry, Volumen 56, Número 8, 1 de agosto de 2010, páginas 1349–1350.
Muhammad Yasir y col. Efectos adversos de los corticosteroides. StatPearls Publishing; 2020 ene.
Leon Margolin y col. El síndrome de abstinencia de esteroides: una revisión de las implicaciones, la etiología y los tratamientos. Revista de dolor y manejo de síntomas. Febrero de 2007. Volumen 33, número 2, páginas 224–228
J Kruh y col. Agentes ahorradores de corticosteroides: inmunosupresores sistémicos convencionales. Desarrollos en Oftalmología. 2012; 51: 29-46.
Martin P. Gallagher y col. Riesgo de cáncer a largo plazo de regímenes inmunosupresores después del trasplante de riñón. J Am Soc Nephrol. 2010 mayo; 21 (5): 852–858.
Francieli Vuolo y col. Evaluación de los niveles séricos de citocinas y el papel del tratamiento con cannabidiol en modelos animales de asma. Mediadores de la inflamación. 2015
L Barbara y col. El perfil de modulación inmune por cannabidiol (CBD) implica la desregulación del factor nuclear de las células T activadas (NFAT). Biochem Pharmacol. 15 de septiembre de 2008; 76 (6): 726–737.
Shakera Halim. ¿Son los esteroides realmente un mal necesario? – Una innovadora alternativa basada en CBD. Salud Europa. 16 de septiembre de 2019
ClinicalTrials.gov. Un estudio de fase 2a para evaluar la seguridad, la tolerabilidad y la eficacia del cannabidiol como terapia ahorradora de esteroides en pacientes con enfermedad de Crohn dependiente de esteroides
ClinicalTrials.gov. Un estudio de fase 2a para evaluar la seguridad y eficacia del cannabidiol solo como terapia de mantenimiento y conservación de esteroides en pacientes con hepatitis autoinmune estable.