Background Cannabinoid-based medicines (CBMs) are being used widely in older people. However, information on the incidence of adverse events (AEs) is limited. Objective To quantify the incidence rate difference (IRD) of AEs in middle aged and older adults of age ≥50 years receiving CBMs and also examine associations with weekly doses. Design Systematic review and meta-analysis. Data sources MEDLINE, PubMed, EMBASE, CINAHL, PsychInfo, Cochrane Library and ClinicalTrials.gov (1st Jan 1990–12th June 2023). Methods We included randomised clinical trials (RCTs) using CBMs with mean participant age ≥50 years for medicinal purposes for all clinical indications. Paired reviewers independently screened studies, extracted data and appraised risk of bias. We estimated pooled effect-sizes IRD under the random-effects model. Results Data from 58 RCTs (37 moderate-high quality studies, pooled n = 6611, mean age range 50–87 years, 50% male, n = 3450 receiving CBMs) showed that compared with controls, the incidence of all-cause and treatment-related AEs attributable to delta-9-tetrahydrocannabinol (THC)-containing CBMs were: THC alone [IRD:18.83(95% Confidence Interval [CI], 1.47–55.79) and 16.35(95% CI, 1.25–48.56)] respectively; THC:cannabidiol (CBD) combination [IRD:19.37(95% CI, 4.24–45.47) and 11.36(95% CI, 2.55–26.48)] respectively. IRDs of serious AEs, withdrawals and deaths were not significantly greater for CBMs containing THC with or without CBD. THC dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects. Conclusions Although CBMs in general are safe and acceptable in middle aged and older adults, one needs to be mindful of certain common dose-dependent side-effects of THC-containing CBMs.

中文翻译：

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中老年人所有适应症由大麻素引起的不良事件：发生率差异的荟萃分析


背景 基于大麻素的药物 （CBM） 在老年人中被广泛使用。然而，关于不良事件 （AEs） 发生率的信息是有限的。目的 量化接受 CBM 的 ≥ 岁 50 岁的中老年人 AEs 的发生率差异 （IRD），并检查与每周剂量的相关性。设计 系统评价和荟萃分析。数据来源 MEDLINE、PubMed、EMBASE、CINAHL、PsychInfo、Cochrane Library 和 ClinicalTrials.gov（1990 年 1 月 1 日至 2023 年 6 月 12 日）。方法 我们纳入了使用 CBMs 的随机临床试验 （RCTs），受试者平均年龄为 ≥50 岁，用于所有临床适应症的药用目的。配对评价员独立筛选研究、提取资料并评估偏倚风险。我们在随机效应模型下估计了合并效应大小的 IRD。结果 来自 58 项随机对照试验（37 项中等高质量研究，合并 n = 6611，平均年龄范围 50-87 岁，50% 男性，n = 3450 名接受 CBM）的数据显示，与对照组相比，归因于含 delta-9-四氢大麻酚 （THC） 的 CBM 的全因和治疗相关 AE 的发生率为：单独的 THC [IRD：18.83（95% 置信区间 [CI]，1.47-55.79）和 16.35（95% CI， 1.25–48.56）] ;THC：大麻二酚 （CBD） 组合 [IRD：19.37（95% CI， 4.24–45.47） 和 11.36（95% CI， 2.55–26.48）] 分别为。对于含有 THC 的 CBM，有或没有 CBD，严重 AEs、退出和死亡的 IRD 并没有显着增加。THC 剂量依赖性地增加了口干、头晕/头重脚轻、行动/平衡/协调困难、分离/思考/感知问题和嗜睡/嗜睡的发生率。每周 THC：CBD 剂量的相互作用主要在神经、精神病和心脏副作用中发挥作用。 结论 尽管 CBM 在中老年人中通常是安全和可接受的，但需要注意含 THC 的 CBM 的某些常见剂量依赖性副作用。