成人斑块牛皮的全身疗法中的nocebo效应:系统性审查和元分析
Bryan Ma1, Ye-Jean Park1,2, Kirk Barber1
1Division of Dermatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Frontiers in medicine
|April 11, 2024
概括
在接受安慰剂的牛皮患者中,有一半发生了不良事件,这表明了nocebo效应. 这些发现影响了患者咨询和银病治疗临床试验设计.
科学领域:
- 皮肤病学 皮肤病学
- 临床药理学 临床药理学
- 精神病体医学是一种精神病体医学.
背景情况:
- 诺塞博效应,即负面期望带来的不良结果,可能会阻碍治疗的坚持.
- 了解nocebo效应对于治疗长期皮肤疾病牛皮至关重要.
研究的目的:
- 定义和量化中度至重度斑块性牛皮患者的nocebo效应.
- 在牛皮临床试验中,比较全身疗法和安慰剂之间的不良事件 (AE) 的发生率.
主要方法:
- 对II-IV期随机对照试验 (RCT) 的系统性审查和元分析,将系统治疗与银病的安慰剂进行比较.
- 搜索包括MEDLINE,Embase和CENTRAL,使用随机效应模型汇集估计.
- 主要结局是任何AE的聚合比例和安慰剂和全身治疗组之间的风险差异 (RD).
主要成果:
- 分析了103项试验,其中包括43,189名患者.
- 综合AE率为系统治疗的57.1%,与安慰剂的49.8%相比 (RD 6.7%,p < 0.00001).
- 与安慰剂相比,生物和非生物系统疗法组中的传染性副作用都较高,但严重的副作用和停止治疗并没有显著差异.
结论:
- 在牛皮临床试验中,近一半的患者从惰性安慰剂中经历了不良事件,可能是由于nocebo效应.
- 这些发现凸显了解决患者期望在牛皮管理中的重要性.
- 未来的研究和患者沟通策略应该考虑nocebo效应的重大影响.
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