CBD As A Steroid-Sparing Treatment
Could cannabidiol be an innovative therapy to replace or teach the use of steroids?
Most of us have been prescribed steroids at some point in our lives. They are often the preferred choice for treating sudden bouts of inflammation, allergies, or when a doctor just doesn’t know what to give a patient. Its immediate effects may seem miraculous. (Oh wow, I suddenly have so much energy, my appetite is back and my mysterious rash is gone.) But long-term use of steroids comes with a number of side effects.
Enter the cannabidiol (CBD), an unexpected competitor for a novel steroid-sparing treatment of the future.
The World is Saved from Steroids
After its first recorded use for rheumatoid arthritis in 1948, Corticosteroids (steroids) quickly became the main 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 overprescribe steroids. Before long, a link between steroids and increased morbidity in patients became apparent, and researchers began finding “steroid-sparing” immunosuppressive drugs. That said, steroids are still prescribed to this day (my dog even got a small dose for a mysterious itch in his right ear), though most doctors limit this to short periods of time.
There is no way out without prison with steroids, which can cause unpleasant and sometimes dangerous side effects.
What are Steroids?
It was Dr. Philip Hench who first postulated that steroids, hormones produced in the adrenal glands, relieve pain associated with rheumatoid arthritis. With the development of corticosteroid medications such as 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 get out of jail pass on steroids, as their use is often accompanied by side effects unpleasant and sometimes dangerous. These include glaucoma, cataracts, fluid retention, high blood pressure, mood swings, weight gain, diabetes, etc. increased risk of infections, 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, acute immunosuppression is required.
However, it is not only the side effects of steroids that can be problematic for patients. Going off steroids, particularly when a patient has been prescribed high doses for a short term or lower doses for a longer period of time, can lead to “steroid withdrawal syndrome“. This happens when the body has become dependent on “pharmaceutical” steroids, leading to its own endogenous production via the hypothalamic-pituitary-adrenal axis (HPA) to weaken and align.
As such, patients should not suddenly stop taking steroids. Instead, the dose should be gradually tapered downwards, otherwise symptoms such as weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain, and headaches may occur.
Steroid Withdrawal
Eve Roginska, a London-based tattoo artist, became dangerously ill with a sudden inflammatory brain disease and was initially given 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 she tried to drop below 20 mg of steroids a day, she experienced debilitating withdrawal symptoms similar to quitting drugs.
“I had terrible migraines and my painkillers weren’t working and sometimes this lasted all day,” Eve recalls. “I had terrible trouble sleeping. Even sleeping pills didn’t work for me anymore. Then all day my body would feel exhausted. A lot of fatigue and a lot of muscle pain. I had brain fog continuously and kept forgetting things.”
Eve was familiar with the oil of CBD, so he decided to see if he could ease his withdrawal symptoms. This may have been little more than an educated hunch, but it paid off.
“Three days after starting with 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 be off them completely by the summer. She has no doubts about the difference CBD has done in his recovery.
“I would probably have to take steroids for the rest of my life if it wasn’t for this oil,” he admits. “He has given me my life back.”
Steroid Drugs
Unbeknownst to Eve, around the same time she was using CBD to stop using steroids, some Israeli scientists were actually researching the CBD as a steroid-sparing treatment.
Los steroid sparing agents they are drugs 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-sparing drugs include cyclophosphamide, chlorambucil, methotrexate, mycophenolate mofetil, azathioprine, cyclosporine, tacrolimus, and sirolimus. That is not to say that taking steroid-sparing agents is a walk in the park. Many of them are classified as chemotherapy drugs and come with their own unpleasant side effects.
“I would probably have to take steroids for the rest of my life if it weren’t for the oil of CBD”.
Eve started taking methotrexate a year after her illness and for the first few months she experienced diarrhea, hair loss, nausea, nail and skin problems, fatigue, abdominal swelling, interruption of her menstrual cycle, urinary tract infections and buccal ulcers. Long-term use of immunosuppressants has also been linked to a increased risk of developing cancer in adulthood.
Not surprisingly, the search for less harmful, steroid-sparing immunosuppressive agents is less harmful, and the CBD it could be near the front of the pack.
Scientists know that the CBD has a general anti-inflammatory/immunosuppressive effect by reducing the production of proinflammatory cytokines and inhibit T cell function. 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-sparing drugs are often first developed to prevent rejection after transplants, and this is also true for CBD. In a small phase-in clinical trial II, Israeli investigators wanted to see if the CBD could prevent graft-versus-host disease (YOURSELF) in steroid-resistant patients. Often a fatal condition, YOURSELF 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 treatment with CBD, and most of them achieved a “complete response.” Although the results have not been published in a peer-reviewed journal, the team behind the study maintains that the CBD “either enhanced the therapeutic effect of steroids or reduced doses of steroids while maintaining or enhancing the therapeutic effect of the steroid. Even more surprising, patients resistant to steroid treatment also showed significant improvement under treatment with CBD.
Encouraged by these encouraging results, they have begun recruiting for phase-in clinical trials II for him CBD as a steroid-sparing treatment in Crohn’s disease and the autoimmune hepatitis. In both trials, patients will gradually switch from their current treatment (steroids or immunosuppressants) to just taking 300 mg of CBD Synthetic daily.
Of course, a phase study II at an early stage does not mean that the CBD, synthetic or otherwise, is a proven and safe alternative to steroids or other immunosuppressive drugs. Also, any decision to reduce or stop steroids should always be made in consultation with your doctor. But it does point to a possible future when the CBD it could be a more benign but equally effective alternative to steroids after transplants and in the treatment of autoimmune diseases.
