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In Reply: We agree with Dr Killestein and colleagues that there are several reasons why our results may differ from those of their brief trial among older patients with multiple sclerosis. These include not only study design, degree and duration of exposure to cannabinoids, and dose and contents of the cannabinoid preparations, but also route of administration and ages of the participants. Nonetheless, we believe that the most important difference is that we studied healthy participants with a history of cannabinoid use. By contrast, Killestein et al¹ examined patients with longstanding multiple sclerosis, a disease related to immune dysfunction.²

Thus, most of our results are consistent with the effects of cannabinoids on immunity previously shown in animal models and tissue culture systems in humans.³ Given the ethical difficulties in conducting clinical trials in which healthy participants would be given repeated doses of cannabis preparations, we believe that our data represent . . . [Full Text of this Article]

Roberta Pacifici, PhD; Piergiorgio Zuccaro, PhD; Simona Pichini, PhD
Laboratorio Biochimica Clinica
Istituto Superiore di Sanitá (ISS)
Rome, Italy

Pere N. Roset, MD, PhD; Sandra Poudevida, PhD; Magí Farré, MD, PhD
Unit of Pharmacology
Institut Municipal d'Investigació Mèdica (IMIM)
Autonomous University of Barcelona
Barcelona, Spain

Jordi Segura, PhD; Rafael de la Torre, PharmD, PhD
Unit of Pharmacology
Institut Municipal d'Investigació Mèdica (IMIM)
Pompeu Fabra University
Barcelona

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Joep Killestein, Bernard M. J. Uitdehaag, and Chris H. Polman
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