Beyond pharmacology: The mediating role of expectations in the experience of side effects in anxious patients treated with secukinumab.
6 affiliations
- 1Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- 2Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- 3Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, 171 77, Sweden.
- 4Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
- 5Deutsches Zentrum Immuntherapie (DZI), University Hospital Erlangen, Erlangen, Germany.
- 6Institute for Medical Education, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Abstract
Introduction
Biologics such as the interleukin-17A inhibitor secukinumab have significantly advanced the treatment of psoriasis. However, when discussing treatments, the role of expectations in the perception of side effects is not yet entirely clear. It is known, however, that negative expectations can cause nocebo effects. We investigated whether side-effect expectations mediate the relationship between trait anxiety and the reporting of side effects during secukinumab therapy.Methods
This post-hoc analysis used data from a randomized controlled trial in adults with moderate-to-severe plaque psoriasis. At the start of the study, trait anxiety and expectations regarding side effects were assessed; self-reported side effects were recorded at weeks 4 and 16. The side-effect outcomes were square-root-transformed prior to analysis to address distributional skew. All mediation steps were estimated using linear regression.Results
Data from N = 104 participants were analyzed. Higher trait anxiety was associated with more self-reported side effects at week 4, but not at week 16. The association at week 4 was mediated by expectations regarding side effects assessed at baseline.Conclusion
The results indicate a nocebo effect in more anxious patients in the first weeks of treatment, with anxiety linked to negative treatment expectations which in turn were associated with the experience of side effects. Over time, the level of experienced side effects decreased significantly, potentially due to positive learning experiences occurring over the course of the treatment. Our findings emphasize the significance of targeted patient-centred communication to optimize treatment adherence.
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BibTeX
@article{muhlhaus2026beyond,
title = {{Beyond pharmacology: The mediating role of expectations in the experience of side effects in anxious patients treated with secukinumab.}},
author = {Senta Mühlhaus and Frederik Krefting and Daniela Bese and Manfred Schedlowski and Wiebke Sondermann and Stefanie Hölsken},
journal = {Brain, behavior, \& immunity - health},
year = {2026},
month = oct,
doi = {10.1016/j.bbih.2026.101376},
url = {https://europepmc.org/article/MED/42908691},
note = {CC BY},
}
RIS
TY - JOUR
TI - Beyond pharmacology: The mediating role of expectations in the experience of side effects in anxious patients treated with secukinumab.
AU - Senta Mühlhaus
AU - Frederik Krefting
AU - Daniela Bese
AU - Manfred Schedlowski
AU - Wiebke Sondermann
AU - Stefanie Hölsken
PY - 2026
DA - 2026/10/05
JO - Brain, behavior, & immunity - health
DO - 10.1016/j.bbih.2026.101376
UR - https://europepmc.org/article/MED/42908691
AB - Introduction Biologics such as the interleukin-17A inhibitor secukinumab have significantly advanced the treatment of psoriasis. However, when discussing treatments, the role of expectations in the perception of side effects is not yet entirely clear. It is known, however, that negative expectations can cause nocebo effects. We investigated whether side-effect expectations mediate the relationship between trait anxiety and the reporting of side effects during secukinumab therapy.Methods This post-hoc analysis used data from a randomized controlled trial in adults with moderate-to-severe plaque psoriasis. At the start of the study, trait anxiety and expectations regarding side effects were assessed; self-reported side effects were recorded at weeks 4 and 16. The side-effect outcomes were square-root-transformed prior to analysis to address distributional skew. All mediation steps were estimated using linear regression.Results Data from N = 104 participants were analyzed. Higher trait anxiety was associated with more self-reported side effects at week 4, but not at week 16. The association at week 4 was mediated by expectations regarding side effects assessed at baseline.Conclusion The results indicate a nocebo effect in more anxious patients in the first weeks of treatment, with anxiety linked to negative treatment expectations which in turn were associated with the experience of side effects. Over time, the level of experienced side effects decreased significantly, potentially due to positive learning experiences occurring over the course of the treatment. Our findings emphasize the significance of targeted patient-centred communication to optimize treatment adherence.
SN - 2666-3546
ER -