First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Clinical Research Unit, Dudley Group NHS Foundation Trust, Dudley, UK.
Nat Rev Rheumatol. 2018 Dec;14(12):727-740. doi: 10.1038/s41584-018-0110-9.
Nocebo effects are noxious reactions to therapeutic interventions that occur because of negative expectations of the patient. In the past decade, neurobiological data have revealed specific neural pathways induced by nocebos (that is, interventions that cause nocebo effects), as well as the associated mechanisms and predisposing factors of nocebo effects. Epidemiological data suggest that nocebos can have a notable effect on medication adherence, clinical outcomes and health-care policy. Meta-analyses of randomized controlled trials (RCTs) of patients with rheumatic and musculoskeletal diseases (RMDs) indicate that withdrawal of treatment by placebo-arm participants owing to adverse events is common; a proportion of these events could be nocebo effects. Moreover, in large-scale, open-label studies of patients with RMDs who transition from bio-originator to biosimilar therapeutics, biosimilar retention rates were much lower than in previous double-blind switch RCTs. This discrepancy suggests that in addition to the lack of response in some patients because of intrinsic differences between the drugs, nocebos might have an important role in low biosimilar retention, thus increasing the need for awareness and early identification of nocebo effects by rheumatologists and allied health-care professionals.
反安慰剂效应是指由于患者的负面预期而对治疗干预产生的有害反应。在过去的十年中，神经生物学数据揭示了反安慰剂（即引起反安慰剂效应的干预措施）所诱导的特定神经通路，以及反安慰剂效应的相关机制和促成因素。流行病学数据表明，反安慰剂可能对药物依从性、临床结果和医疗保健政策产生显著影响。对风湿和肌肉骨骼疾病（RMD）患者的随机对照试验（RCT）的荟萃分析表明，由于不良事件，安慰剂组参与者停止治疗的情况很常见；这些事件中有一部分可能是反安慰剂效应。此外，在接受生物原研药转为生物类似药治疗的 RMD 患者的大规模、开放性研究中，生物类似药的保留率远低于之前的双盲转换 RCT。这种差异表明，除了由于药物之间的内在差异导致某些患者缺乏反应之外，反安慰剂在低生物类似药保留率中可能具有重要作用，因此风湿科医生和相关医疗保健专业人员需要提高对反安慰剂效应的认识和早期识别。
