Results From an Italian Expanded Access Program on Cannabidiol Treatment in Highly Refractory Dravet Syndrome and Lennox–Gastaut Syndrome

Luigi Francesco Iannone, Gabriele Arena, Domenica Immacolata Battaglia, Francesca Bisulli, Paolo Bonanni, Antonella Boni, Maria Paola Canevini, Gaetano Cantalupo, Elisabetta Cesaroni, Manuela Contin, Antonietta Coppola, Duccio Maria Cordelli, Giovanni Cricchiuti, Valentina De Giorgis, Maria Fulvia De Leva, Marta De Rinaldis, Giuseppe D'Orsi, Giovanni Maria D'Orsi, Maurizio Elia, Carlo Andrea GalimbertiAlessandra Morano, Tiziana Granata, Renzo Guerrini, Monica A. M. Lodi, Angela La Neve, Francesca Marchese, Silvia Masnada, Roberto Michelucci, Margherita Nosadini, Nicola Pilolli, Dario Pruna, Francesca Ragona, Anna Rosati, Margherita Santucci, Alberto Spalice, Nicola Pietrafusa, Pasquale Striano, Elena Tartara, Laura Tassi, Amanda Papa, Claudio Zucca, Emilio Russo, Elisa Russo, Oriano Mecarelli

Research output: Contribution to journalArticlepeer-review


Background: Purified cannabidiol (CBD) was administered to highly refractory patients with Dravet (DS) or Lennox–Gastaut (LGS) syndromes in an ongoing expanded access program (EAP). Herein, we report interim results on CBD safety and seizure outcomes in patients treated for a 12-month period. Material and Methods: Thirty centers were enrolled from December 2018 to December 2019 within the open-label prospective EAP up to a maximum of 25 mg/kg per day. Adverse effects and liver function tests were assessed after 2 weeks; 1, 3, and 6 months of treatment; and periodically thereafter. Seizure endpoints were the percentage of patients with ≥50 and 100% reduction in seizures compared to baseline. Results: A total of 93 patients were enrolled and included in the safety analysis. Eighty-two patients [27 (32.9%) DS, 55 (67.1%) LGS] with at least 3 months of treatment have been included in the effectiveness analysis; median previously failed antiseizure medications was eight. Pediatric and adult patients were uniformly represented in the cohort. At 3-month follow-up, compared to the 28-day baseline period, the percentage of patients with at least a 50% reduction in seizure frequency was 40.2% (plus 1.2% seizure-free). Retention rate was similar according to diagnosis, while we found an increased number of patients remaining under treatment in the adult group. CBD was mostly coadministered with valproic acid (62.2%) and clobazam (41.5%). In the safety dataset, 29 (31.2%) dropped out: reasons were lack of efficacy [16 (17.2%)] and adverse events (AEs) [12 (12.9%)], and one met withdrawal criteria (1.1%). Most reported AEs were somnolence (22.6%) and diarrhea (11.9%), followed by transaminase elevation and loss of appetite. Conclusions: CBD is associated with improved seizure control also in a considerable proportion of highly refractory patients with DS and LGS independently from clobazam use. Overall, CBD safety and effectiveness are not dose-related in this cohort.
Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalFrontiers in Neurology
Publication statusPublished - 2021


  • Dravet syndrome
  • cannabidiol
  • epilepsy
  • expanded access program
  • lennox-gastaut syndrome


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