Mitigating the Nocebo Effect in Biosimilar Use and Switching: A Systematic Review

Area of Science:

• Pharmacoeconomics and Patient Safety
• Biosimilar Therapeutics and Healthcare Access

Background:

• Patient nocebo effects, triggered by negative perceptions of biosimilars, can diminish therapeutic benefits and worsen adverse events.
• Biosimilars are vital for reducing healthcare costs and increasing global access to biologics, necessitating strategies to manage potential nocebo responses.

Purpose of the Study:

• To systematically review strategies for minimizing nocebo effects in clinical practice, specifically within biosimilar switching contexts.
• To propose evidence-based recommendations for mitigating nocebo effects associated with biosimilar transitions.

Main Methods:

• Systematic literature review of biomedical databases (PubMed, Embase) using keywords: nocebo, biosimilar, mitigation, strategy, prevention.
• Search supplemented by snowballing; study quality assessed using established appraisal tools.
• Screened 1617 records, including 60 for final analysis.

Main Results:

• Ten studies focused on biosimilar switching, with 7 testing nocebo mitigation strategies.
• Fifty studies outside the biosimilar context identified 46 mitigation strategies.
• Thirteen distinct strategies were identified for biosimilar switching, including communication techniques, patient/professional education, and organizational adjustments.

Conclusions:

• A range of tested strategies can be applied by healthcare professionals to mitigate nocebo effects during biosimilar switching.
• Implementing a combination of strategies before, during, and after the switch is recommended for patients and healthcare providers.
• Further research is needed to determine the effect size of individual and combined strategies due to limited studies in the biosimilar context.