All drugs are not equal. Some are more harmful than beneficial, and ought to be avoided, until such time as they are withdrawn from the market.

From 2010 to 2014, ongoing analysis by the independent French medical journal Prescrire has identified 71 drugs currently on the market in France that are more dangerous than beneficial.

They include:

• Active substances with adverse effects that are disproportionate to the benefits they provide;
• Older drugs that have been superseded by new drugs with a better harm-benefit balance;
• Recent drugs that have a less favourable harm-benefit balance than existing options;
• Drugs that have no proven efficacy (beyond the placebo effect) but that carry a risk of serious adverse effects.

All Prescrire's assessments of new drugs and indications are based on a systematic and reproducible literature search. The resulting data are then analysed by an editorial team using an established procedure:

• Efficacy data are prioritised: most weight is given to studies providing solid supporting evidence, i.e. well-conducted, double-blind, randomised controlled trials;
• The new drug is compared with a carefully chosen standard treatment (not necessarily a drug);
• The accent is placed on those clinical endpoints most relevant to the patients concerned. This means that we sometimes ignore surrogate endpoints such as simple laboratory markers that have not been shown to correlate with a favourable clinical outcome.

The goal of this analysis is to facilitate the choice of quality care, and above all to do no harm to patients.

©Prescrire 1 February 2015

"Towards better patient care: drugs to avoid in 2015" Prescrire Int 2015; 24 (158): 78-1–78-6. (pdf, free).