The nocebo effect is defined as the incitement or the worsening of symptoms induced by any negative attitude from non-pharmacological therapeutic intervention, sham, or active therapies. When a patient anticipates a negative effect associated with an intervention, medication or change in medication, they may then experience either an increase in this effect or experience it de novo. Although less is known about the nocebo effect compared with the placebo effect, widespread interest in the nocebo effect observed with statin therapy and a literature review highlighting the nocebo effect across at least ten different disease areas strongly suggests this is a common phenomenon. This effect has also recently been shown to play a role when introducing a medication or changing an established medication, for example, when switching patients from a reference biologic to a biosimilar. Given the important role biosimilars play in providing cost-effective alternatives to reference biologics, increasing physician treatment options and patient access to effective biologic treatment, it is important that we understand this phenomenon and aim to reduce this effect when possible. In this paper, we propose three key strategies to help mitigate the nocebo effect in clinical practice when switching patients from reference biologic to biosimilar: positive framing, increasing patient and healthcare professionals' understanding of biosimilars and utilising a managed switching programme.

Department of Dermatology Hospital de la Santa Creu i Sant Pau Autonomous University of Barcelona Barcelona Spain

Department of Dermatology Venereology and Allergy Charité Universitätsmedizin Berlin Germany

Department of Internal Medicine Rheumatology Schlosspark Klinik University Medicine Berlin Berlin Germany

Department of Rheumatology Diakonhjemmet Hospital Oslo Norway

Department of Rheumatology Sint Maartenskliniek and Radboud University Medical Centre Nijmegen The Netherlands

Hospital Pharmacy Erasmus University Medical Center Rotterdam The Netherlands Department of Pharmaceutical and Pharmacological Sciences KU Leuven Leuven Belgium

Institute of Rheumatology Prague Czech Republic

Parker Institute University of Copenhagen Bispebjerg og Frederiksberg Frederiksberg Denmark Department of Internal Medicine Rheumatology Lund University Lund Sweden

Pharmacy Department Hospital de la Santa Creu i Sant Pau Barcelona Spain

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