Department of Internal Medicine VI, University Hospital Tübingen, 72076 Tübingen, Germany.
Nat Rev Drug Discov. 2013 Mar;12(3):191-204. doi: 10.1038/nrd3923.
Our understanding of the mechanisms mediating or moderating the placebo response to medicines has grown substantially over the past decade and offers the opportunity to capitalize on its benefits in future drug development as well as in clinical practice. In this article, we discuss three strategies that could be used to modulate the placebo response, depending on which stage of the drug development process they are applied. In clinical trials the placebo effect should be minimized to optimize drug-placebo differences, thus ensuring that the efficacy of the investigational drug can be truly evaluated. Once the drug is approved and in clinical use, placebo effects should be maximized by harnessing patients' expectations and learning mechanisms to improve treatment outcomes. Finally, personalizing placebo responses - which involves considering an individual's genetic predisposition, personality, past medical history and treatment experience - could also maximize therapeutic outcomes.
在过去的十年中，我们对介导或调节药物安慰剂反应的机制的理解有了很大的提高，这为我们在未来的药物开发以及临床实践中利用其益处提供了机会。在本文中，我们讨论了三种策略，根据它们在药物开发过程中的应用阶段，可以用来调节安慰剂反应。在临床试验中，应该尽量减少安慰剂效应，以优化药物-安慰剂差异，从而确保可以真正评估研究药物的疗效。一旦药物获得批准并在临床使用，就应该通过利用患者的期望和学习机制来最大化安慰剂效应，以改善治疗效果。最后，通过考虑个体的遗传倾向、个性、既往病史和治疗经验来个性化安慰剂反应，也可以最大限度地提高治疗效果。
