Sativex cost-effective in final NICE guideline on cannabis-based medicines

Sativex is a cost effective treatment for people with MS spasticity according to new guidance published today by NICE.  This reverses the decision made in draft guidance published earlier this year.

The guideline recommends that, providing the local NHS health authority is willing to pay for continued treatment, a 4-week trial of Sativex can be offered to people with moderate to severe MS-related spasticity which has not been improved by other treatments.  At the end of the trial, if their spasticity-related symptoms have improved by at least 20%, they can continue taking Sativex.

The MS Trust is extremely pleased that people with MS in England will have better access to Sativex.  As a charity, we have campaigned over a long period for Sativex to be widely available and we are delighted that NICE has listened to our calls for a fair assessment of its cost effectiveness.  We know that access to this drug will greatly improve quality of life for many in the MS community.  At the same time, we also recognise that some local health authorities will not be able to fund continued treatment with Sativex.  The challenge ahead is to ensure that everyone eligible can access this treatment.

- David Martin, Chief Executive Officer, MS Trust

Spasticity and spasms are two of the symptoms Dave experiences. When Dave has a full body spasm, it almost looks like somebody has shot 50,000 volts through him. His body just stiffens up like an ironing board and then he starts violently shaking. He often gets them at night which means he can’t get a good night’s sleep. The sound of his bed shaking at night can be so violent it keeps me up too.

Dave has tried different treatments for spasms and spasticity, but nothing worked for him.  But then he was prescribed Sativex and it has massively, massively improved his quality of life. It’s not a miracle cure, but it has allowed him to get a good night’s sleep. It doesn’t work for everybody, but I do believe that anybody with MS who suffers from spasms and spasticity and has tried all the first line treatments, should have the opportunity to at least try it and see if it works for them.

- Jen, Dave’s wife

About Sativex

Sativex is a mouth spray prepared from cannabis plants and contains two chemicals - tetrahydrocannabinol (THC) and cannabidiol (CBD) - in equal proportions.  The number of sprays is gradually increased each day until a dose is reached which relieves muscle stiffness but with the fewest side effects. 

Sativex has been studied extensively in clinical trials and is licensed in the UK as an add-on treatment for spasticity where other drugs have failed.  It can only be prescribed by specialist doctors with experience of treating MS spasticity – consultant neurologists, consultant rehabilitation specialists and consultant pain specialists.   For those who respond to Sativex, ongoing prescriptions can be managed by a GP.

Although Sativex can be prescribed, it is not considered to be a cost-effective treatment for the NHS in Scotland or Northern Ireland.  In Wales, it is considered cost-effective and is approved as an NHS treatment, although availability is still limited.

About the Guideline

In November 2018, the legal status of cannabis was amended to allow specialist clinicians to legally prescribe cannabis-based medicinal products to people with an exceptional clinical need.

To support this change, NICE (National Institute for Health and Care Excellence) has reviewed evidence for the benefits and costs of cannabis-based medicinal products.  The guideline gives guidance for health professionals and the public in England on prescribing cannabis-based medicines for intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.

The guideline does not support the use of cannabis-based medicinal products for chronic pain but recommends further research to evaluate the effect of cannabidiol as an add-on to standard treatments for nerve pain.