In just a few years CBD has gone from a niche curiosity to one of the fastest-growing industries in the world. While much of its popularity can be chalked up to marketing type, there’s also a science-based reason for it — the endocannabinoid system, which CBD interacts with, regulates many of our body’s normal functions. One of the most important of these is the inflammatory response, which steroids are also used to manage.
When we talk about steroids in this context, we’re not talking about the ones related to testosterone used by bodybuilders to get bigger biceps. Those are known as anabolic steroids, and their medical applications are limited. Corticosteroids, on the other hand, are one of the go-to tools of many medical professionals for immunosuppression and treatment of non-infectious inflammatory conditions— and these are the ones that an upstart research firm are seeking to replace with CBD.
According to a 2017 research paper in the British Medical Journal, around 20 percent of American adults have received a prescription for oral corticosteroids in the last three years, “with an associated increased risk of adverse events,” according to the study’s authors.
Interestingly, these numbers are much lower in some other developed countries. In the U.K. for example, a 2000 paper in the Quarterly Journal of Medicine estimated that just 0.9 percent of the adult population had received one or more prescriptions for oral corticosteroids, though that number rose to 2.5 percent for people aged between 70 and 79.
Steroids are commonly prescribed to people with inflammatory conditions, joint diseases like arthritis, autoimmune diseases, and respiratory diseases — even as part of cancer treatment regimens, especially lymphomas. Steroids are also used on occasion to prevent serious allergic responses to some types of chemotherapy.
The most promising movement on this front comes from the Israeli cannabis clinical research startup STERO Biotechs, which is currently working on a number of CBD-based treatments for severe inflammatory diseases, especially those affecting the liver.
In 2018, the company received a U.S. patent on the “steroid-sparing CBD-based treatment” of over 100 autoimmune and chronic inflammatory diseases. Its leaders had previously founded another cannabis research firm: Talent Biotechs, which sold its CBD-based treatment technologies for the prevention of organ transplant complications to international pharmaceutical company Kalytera Therapeutics, completing one of the first-ever multi-million dollar exits for a cannabis company.
STERO has already initiated two Phase 2 trials for its CBD-based treatments, one for autoimmune hepatitis (AIH) and the other for steroid-dependent Crohn’s disease. For both conditions, the resultant inflammation can be severe and even fatal, often requiring lifelong treatment with steroids. Additional trials are planned for later this year, though the company hasn’t specified their focus.
Liver diseases such as AIH are a major health concern globally — each year, they’re responsible for 2 million deaths, 3.5 percent of all deaths worldwide, according to a 2019 paper in the Journal of Hepatology.
Steroids work by decreasing inflammation and reducing the activity of the immune system, and many who take them find their lives disrupted by the side effects, which can be fatal in some cases.
According to the Mayo Clinic, a non-exhaustive list of the most commonly reported side effects from long-term exposure to steroids includes:
Despite the relative scarcity of research on CBD’s medical applications, one of the common themes to emerge so far is its positive safety profile — when the World Health Organization (WHO) recommended relaxing global restrictions on CBD, it stated that the cannabinoid has no potential for abuse or significant side effects. This is a key reason CBD has emerged as an alternative to traditional painkillers and sleep aids, and it also lies at the heart of its appeal as a replacement for steroids, which can sometimes hurt patients as much as they help.
Any statement about CBD’s potential for treating a given condition comes with the caveat that research is still in its (very) early stages. At the same time, so far CBD has shown promising signs that it could treat the same types of conditions as steroids with few of the side effects.
However, this bears watching: In trials of the first FDA-approved CBD treatment, Epidiolex (which contains very high doses of CBD compared to that of typical “wellness products”), up to 20 percent of pediatric seizure patients developed elevated liver enzyme levels and had their participation curtailed.
While this is certainly concerning, it doesn’t necessarily follow that CBD is bad for your liver. Since many of the patients involved in that study were also on other medications, it’s difficult to pinpoint the exact cause of their adverse reactions. Many experts believe that the fears about CBD causing liver damage are somewhat exaggerated, with its adverse effects due to excessive dosages rather than any characteristics of the cannabinoid itself. What’s more, some have suggested that these liver injuries are reversible.
In addition, outside of STERO’s early clinical trial returns, there has been a wealth of recent studies demonstrating CBD’s potential applications in liver disease treatment.
In 2010, an animal study from Greek and Israeli researchers in the British Journal of Pharmacology found that CBD had promise for restoring neurological, cognitive and motor functions resulting from acute or chronic liver failure — indicating that it may be useful in combating some of the deterioration that accompanies late-stage liver disease. In humans, a 2018 paper in the journal Liver International showed that CBD was effective at reducing the prevalence of progressive alcohol-induced liver disease.
Whether or not CBD may exacerbate or help heal potential cirrhosis resulting from different forms of viral hepatitis and other types of liver damage is still unknown. However, preliminary pre-clinical research indicates CBD may have anti-hepatitis C properties.
Dr. Assaf Issachar, a senior physician in the Liver Institute at the Rabin Medical Centre in Israel, is running STERO’s clinical trial on AIH. He believes that if CBD can be shown to prevent flare-ups of AIH, it could have a massive impact on quality of life for people who must currently use steroids to manage these life-threatening episodes.
As Issachar told HealthEuropa, “I am very excited about this clinical trial, as CBD treatment could potentially prove to be a safe and effective steroid-sparing option for such patients.”