Placebo and nocebo effects are shaped by learning processes that influence treatment outcomes. By utilizing these effects, the tapering schedules of medication can be refined to reduce drug use while maintaining remission. The ReumaNL long-term Excellence project applies this approach to the tapering of biological drugs used in the treatment of rheumatoid arthritis (RA). Current guidelines recommend tapering biological drugs after remission to reduce side effects and healthcare costs. The ReumaNL project explores optimizing tapering of biological drugs using advanced placebo techniques, focusing on three key aspects of treatment: learning processes in doctors, patients and in the drugs to be tapered.
Learning processes play an important role in placebo and nocebo effects of treatments and can possibly be used to optimize the tapering of medicines and to be able to apply a more tailored treatment approach:
- Doctor-patient communication can directly contribute to more beneficial treatment effects, e.g. aimed at reducing patients' excessive fears of side effects or relapse. Different forms of communication training (e.g. through eLearning or Virtual Reality) were developed by the research group to train doctors.
- Many patients are concerned about disease flare during drug tapering. Training (e.g. patient education) aimed at reinforcing positive expectations about the treatment outcome in patients can be used to reduce negative expectations, stress and anxiety. And consequently, reduce the risk of disease flare due to nocebo effects during tapering.
- Finally, research in humans and animals shows that pharmacological conditioning can enhance the effects of drugs, reducing the dosage of drugs needed for the same effect. In pharmacological conditioning, signals derived from the context - for example a drink together with the injection liquid or pill - are linked to the effect of the drug. Over time, these contextual cues can trigger the effects of the drug itself.
Until now, however, these treatment strategies have not been applied before in the tapering of biologicals in RA patients.
The project involves two long-term multicenter randomized studies:
1. Evaluating the impact of communication training for rheumatologists on their prescribing behavior and patient outcomes.
2. Investigating the combination of expectancy training and pharmacological conditioning in RA patients to enhance remission rates and reduce disease flares during tapering.
These strategies, previously successful in other settings, are expected to reduce flare rates, maintain remission, and allow tailored treatment approaches based on patient profiles. This innovative program integrates cutting-edge research to personalize RA treatment, minimize drug use, and maximize cost-effectiveness without adding burden to patients or doctors.
Researchers involved:
Andrea Evers, Judy Veldhuizen, Aleksandrina Skvortsova, Liesbeth van Vliet, Stefanie Meeuwis, Henriet van Middendorp
PhD students:
Pien van der Velde, Victor Leong
