OPINION The placebo response in medicine: minimize, maximize or personalize?
OPINION The placebo response in medicine: minimize, maximize or personalize?
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DOI：
10.1038/nrd3923
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发表时间：
2013-03-01
影响因子：
120.1
通讯作者：
Rief, Winfried
中科院分区：
文献类型：
--
作者：
Enck, Paul;Bingel, Ulrike;Rief, Winfried
在过去的十年中，我们对调解或调节安慰剂对药物反应的机制的理解有了很大的增长，并提供了在未来药物开发和临床实践中利用其益处的机会。在这篇文章中，我们讨论了三种可用于调节安慰剂反应的策略，这取决于它们应用于药物开发过程的哪个阶段。在临床试验中，应尽量减少安慰剂效应，以优化药物-安慰剂差异，从而确保能够真实评价试验药物的疗效。一旦药物获得批准并投入临床使用，应通过利用患者的期望和学习机制来最大限度地发挥安慰剂的作用，以改善治疗效果。最后，个性化的安慰剂反应--包括考虑个人的遗传倾向、个性、既往病史和治疗经验--也可以最大限度地提高治疗效果。
Our understanding of the mechanisms mediating or moderating the placebo response to medicines has grown substantially over the past decade and offers the opportunity to capitalize on its benefits in future drug development as well as in clinical practice. In this article, we discuss three strategies that could be used to modulate the placebo response, depending on which stage of the drug development process they are applied. In clinical trials the placebo effect should be minimized to optimize drug-placebo differences, thus ensuring that the efficacy of the investigational drug can be truly evaluated. Once the drug is approved and in clinical use, placebo effects should be maximized by harnessing patients' expectations and learning mechanisms to improve treatment outcomes. Finally, personalizing placebo responses - which involves considering an individual's genetic predisposition, personality, past medical history and treatment experience - could also maximize therapeutic outcomes.