Variability in Serum Concentrations and Clinical Response in Artisanal Versus Pharmaceutical Cannabidiol Treatment of Pediatric Pharmacoresistant Epilepsy

Authors

Nathan T. Cohen, Comprehensive Pediatric Epilepsy Program (NTC, JAC, JMS), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC.
Burak Bahar, Division of Pathology & Laboratory Medicine (BB), Children's National Hospital, Washington, DC.
Joan A. Conry, Comprehensive Pediatric Epilepsy Program (NTC, JAC, JMS), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC.
John M. Schreiber, Comprehensive Pediatric Epilepsy Program (NTC, JAC, JMS), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG

Volume

27

Issue

6

DOI

10.5863/1551-6776-27.6.558

Keywords

Dravet syndrome; Epidiolex; Lennox-Gastaut syndrome; artisanal cannabidiol; cannabidiol; pediatric epilepsy

Abstract

OBJECTIVE: We hypothesized that serum cannabidiol (CBD) concentrations would be higher in patients taking pharmaceutical- versus artisanal-CBD oil, and higher serum CBD concentrations would correlate with increased side effects and decreased seizure frequency. METHODS: This was a retrospective chart review. We included patients with pharmacoresistant epilepsy, treated with artisanal-CBD or pharmaceutical-CBD (Epidiolex), and with quantitative serum CBD concentrations. We tracked epilepsy diagnosis, artisanal-CBD dosage, pharmaceutical-CBD dose, serum CBD concentration, clobazam concentration, N-desmethylclobazam concentration, seizure history (frequency of motor seizures), response to medication (percentage reduction in motor seizures), and side effects. RESULTS: Forty-two patients met inclusion criteria. Mean serum CBD concentration was 51.1 ng/mL (artisanal group) and 124 ng/mL (pharmaceutical group) (p = 0.022). Patients receiving artisanal-CBD had no change in median overall seizures (IQR, -50% to 50%); the pharmaceutical-CBD group had median 50% reduction (IQR, -90% to no change) (p = 0.199). CONCLUSIONS: Pharmaceutical-CBD achieves higher serum CBD concentrations than artisanal-CBD in pediatric patients with refractory epilepsy. These higher CBD concentrations are associated with increased reported adverse effects, but no detectable difference in seizure frequency.

APA Citation

Cohen, Nathan T.; Bahar, Burak; Conry, Joan A.; and Schreiber, John M., "Variability in Serum Concentrations and Clinical Response in Artisanal Versus Pharmaceutical Cannabidiol Treatment of Pediatric Pharmacoresistant Epilepsy" (2022). GW Authored Works. Paper 1575.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1575

Department

Pediatrics