For the sixth consecutive year, the independent French medical journal Prescrire has published its review of "Drugs to avoid, in the name of better patient care". This report identifies drugs whose dangers clearly outweigh their benefits and which ought to be avoided. The aim is to help healthcare professionals and patients choose high-quality treatments, first to do no harm to patients, and to minimise adverse effects.

Prescrire's assessment of the harm-benefit balance of a drug in a given situation is based on a rigorous, collective procedure that includes a systematic and reproducible literature search, identification of patient-relevant outcomes, prioritisation of the supporting data based on the strength of evidence, comparison with standard treatments, and an analysis of both known and potential adverse effects.

The 2018 update, published in the February issue of the French edition, covers drugs analysed from 2010 to 2017 and includes 90 drugs (of which 79 are currently on the market in France) that are more harmful than beneficial in all the indications for which they have been authorised in France or in the European Union.

7 drugs that were listed in 2017 have been removed, 3 because they were withdrawn from the market and 4 because Prescrire's editors are currently analysing new data. 5 drugs have been added to the 2018 update.

Even in serious situations, when no effective treatment exists, there is no justification for prescribing a drug with no proven efficacy that provokes severe adverse effects. It may be acceptable to test these drugs in clinical trials, but patients must be informed of the uncertainty over their harm-benefit balance, and the trial design must be relevant. Tailored supportive care is the best option when there are no available treatments capable of improving prognosis or quality of life, beyond their placebo effect.

The updated review will be published in English in the April edition of Prescrire International. The text is available for free download below. 

©Prescrire 25 January 2018

"Towards better patient care: drugs to avoid in 2018" Prescrire International 2018; 27 (192): 107-1 - 107-9 (Pdf, free)

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