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Eur J Clin Pharmacol. 2018 May;74(5):655-661. doi: 10.1007/s00228-018-2418-4. Epub 2018 Jan 24.

The nocebo effect challenges the non-medical infliximab switch in practice.

Author information

1
Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, PO Box 5500, NL, 6162 BG, Heerlen, Sittard-Geleen, The Netherlands. nwboone@gmail.com.
2
Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Centre, Heerlen, Sittard-Geleen, The Netherlands.
3
Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, PO Box 5500, NL, 6162 BG, Heerlen, Sittard-Geleen, The Netherlands.
4
Department of Clinical pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands.
5
Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Sittard-Geleen, The Netherlands.
6
Amsterdam Rheumatology & Immunology Centre, Amsterdam-Zuidoost, The Netherlands.
7
Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Abstract

BACKGROUND:

In clinical practice, non-medical switching of biological medication may provoke nocebo effects due to unexplained deterioration of therapeutic benefits. Indication extrapolation, idiosyncratic reactions, and interchangeability remain challenged in clinical practice after biosimilar approval by the European Medicines Agency. The principle of "first do no harm" may be challenged in a patient when switching from originator to biosimilar biological.

AIM:

To describe the 1-year results of a pragmatic study on infliximab biosimilar implementation in immune-mediated inflammatory disease patients on the basis of shared decision-making under effectiveness and safety monitoring.

METHODS:

Inflammatory bowel disease and rheumatology patients on infliximab originator were converted to infliximab biosimilar after providing informed consent. Nocebo response patients were monitored after switch back to originator. Linear mixed models were used to analyze continuous endpoints on effectiveness and laboratory outcomes to determine significance (P ≤ 0.05) of change over time after switching.

RESULTS:

After inviting 146 patients, a group of 125 patients enrolled in the project over time, respectively, 73 Crohn's disease, 28 ulcerative colitis, nine rheumatoid arthritis, ten psoriatic arthritis, and five ankylosing spondylitis patients. No statistically significant changes in effectiveness and safety were observed in any of the indications after a median of 4 infusions in 9 months of study. An overall nocebo response of 12.8% was found among the patients during a minimal observation period of 6 months after the transition to biosimilar infliximab. The overall nocebo response rate did not differ between the studied indications.

CONCLUSIONS:

In inflammatory bowel disease and rheumatological patients, similar effectiveness and safety were demonstrated on the transition into infliximab biosimilar. In our series, patient empowerment and registration of treatment outcomes delineated biosimilar transition, an approach that hypothetically could reduce nocebo response rates which are relevant to account for regarding biosimilar implementation.

KEYWORDS:

Ankylosing spondylitis; Crohn’s disease; Inflammatory bowel disease; Nocebo-effect; Non-medical switch; Psoriatic arthritis; Rheumatoid arthritis; Ulcerative colitis

PMID:
29368188
PMCID:
PMC5893662
DOI:
10.1007/s00228-018-2418-4
[Indexed for MEDLINE]
Free PMC Article

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