To See or NOsee: The Debate on the Nocebo Effect and Optimizing the Use of Biosimilars

Adv Ther. 2018 Jun;35(6):749-753. doi: 10.1007/s12325-018-0719-8. Epub 2018 Jun 5.


In addition to the general clinical benefit offered, biosimilars may not only generate savings for healthcare budgets but also improve patient access to biologic products. Since the first biosimilar was approved in Europe in 2006, a further 36 different biosimilar drugs have been approved for several indications. Despite the wealth of experience gained and the reported data supporting the use of biosimilars, both in naïve and biologic-experienced patients, some healthcare professionals continue to express doubt regarding the rigorous approval process for biosimilars and uncertainty with how to incorporate them into daily clinical practice. These opinions can be transferred to patients through poor or lack of communication, meaning that patients may lack confidence in treatment quality and, as a result, be susceptible to the nocebo effect. At the 2017 American College of Rheumatology/Association of Rheumatology Health Professionals annual meeting, during a debate the question was asked as to whether the nocebo effect was in fact being used to describe "any result you don't agree with". Here, we detail that the nocebo effect has been demonstrated in a number of clinical trials, and that this effect may negatively affect acceptance in patients switching from an originator product to a biosimilar. Awareness of the potential for the nocebo effect and adoption of enhanced communication techniques may be useful in mitigating the nocebo effect. Effective healthcare professional-patient dialogue is key in transferring confidence to the patient, and has been shown to reduce nocebo effects in patients when switching from an originator to a biosimilar.

Funding: Biogen International GmbH.

Keywords: Biosimilar; Education; Nocebo effect; Physician–patient dialogue.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / therapeutic use*
  • Biosimilar Pharmaceuticals / therapeutic use*
  • Communication*
  • Europe
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nocebo Effect*
  • Patient Preference / psychology*
  • Physician-Patient Relations
  • Rheumatic Diseases / drug therapy*


  • Antirheumatic Agents
  • Biosimilar Pharmaceuticals