Prescrire's assessment of a drug's harm-benefit balance in a given situation is underpinned by a rigorous procedure based on: a systematic and reproducible literature search; data on patient-relevant outcomes; prioritisation of the highest-level evidence; comparison with standard treatment, if one exists; and appraisal of the drug's known, foreseeable and suspected adverse effects.

Our 2024 review of drugs to avoid covers all the drugs examined by Prescrire between 2010 and 2023 that are authorised in the European Union or in France. It consists of 105 drugs that are more harmful than beneficial in all their approved indications.

In most situations, when drug therapy appears to be the best course of action, other drugs with a better harm-benefit balance are available. And in some situations, the most prudent option is to forgo drug therapy.

Even when seriously ill patients have exhausted all other treatment options, there is no justification for exposing them to drugs with serious adverse effects that have not been shown to improve clinical outcomes. It is sometimes acceptable to test such drugs in clinical trials, provided that patients are made fully aware of the uncertainties surrounding the drug's harm-benefit balance, as well as the trial's objectives, through discussions tailored to the patient's level of understanding. When such patients choose not to take part in a clinical trial, appropriate support and symptomatic care are called for, to help them cope with the absence of any effective drug-based options that could improve their prognosis or quality of life.

©Prescrire 1 February 2024

Source: "Towards better patient care: drugs to avoid in 2024" Prescrire Int 2024; 33 (256): 50-1 - 50-11. Free.

For more about this year's update:
Drugs to avoid: a reliable, rigorous, independent analysis > HERE
Drugs to avoid: main changes in the 2024 update > HERE

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