Research study · Medical Sciences · 2026
Nabiximols in Multiple Sclerosis: Beyond Spasticity-An Exploratory Systematic Review and Meta-Analysis of Symptomatic Outcomes
Verified on PubMed Systematic review or meta-analysis
A 2026 meta-analysis in Medical Sciences tested cannabidiol in multiple sclerosis. The results were mixed and the evidence is weak. This review suggests the spray may ease several symptoms beyond stiffness in people with multiple sclerosis, but it does not prove it works for them.
In plain language
Study overview
This review pooled results from many earlier studies of a mouth spray containing two cannabis compounds, called nabiximols, in adults with multiple sclerosis. The researchers looked at whether it helped with problems other than the muscle stiffness it is already approved for, such as bladder, sleep, muscle spasms and walking.
Findings
The results were mixed and the evidence is weak. Across the pooled studies, the spray appeared to help with several symptoms, but the studies were varied and mostly not strong enough to be sure.
The deeper readScientific analysis
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 = −16.87; 95% CI = (−29.75)–(−3.99)), bladder function (MD = −16.38; 95% CI = (−22.18)–(−10.58)), sleep disruption (MD = −15.75; 95% CI = (−22.02)–(−9.49)) and gait function (timed walk MD(s) = −5.31; 95% CI(s) = (−9.88)–(−0.74)) 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)–(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 “spasticity-plus” concept. However, the evidence certainty was low to very low, and these findings should be considered exploratory.
The paper
Citation
Kleiner D, Horváth IL, Mátis D, Nagy R, Gergő D, Lugosi K, et al. Nabiximols in Multiple Sclerosis: Beyond Spasticity—An Exploratory Systematic Review and Meta-Analysis of Symptomatic Outcomes. Medical Sciences (2026). PubMed 42506315 · DOI
Limitations the authors noted
Substantial heterogeneity (I2 often above 85%). Most of the evidence came from open-label, before-after and observational designs susceptible to placebo effect and regression to the mean. Outcomes were mostly secondary outcomes of trials, with sample sizes often not disclosed. No formal sample-size calculation (exploratory design). Outcome measures varied and required mathematical recalculation. Serious risk of bias on ROBINS-I across most domains, mainly selection bias and missing data. Some included studies were pilot studies with small samples. Exploratory analysis, not confirmatory.
In practice
Why this matters
This review suggests the spray may ease several symptoms beyond stiffness in people with multiple sclerosis, but it does not prove it works for them. The studies were of mixed quality and many were not randomized comparisons, so the results could partly reflect the natural course of the illness or the placebo effect. Questions remain about the right dose, how long to try it, and which patients are most likely to benefit.
Browse related research
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Reviewed by Dr. Caplan on October 16, 2026.
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