Prescrire updates its review of drugs to avoid every year, in the interests of improving patient care. No new drugs to avoid have been added to our 2024 review. However, it still includes a large number of drugs that are more dangerous than beneficial, indicating that health authorities are not doing enough to protect patients.
Faced with this situation, this review aims to provide crucial information to help healthcare professionals to avoid exposing patients to drugs that carry disproportionate risks. It also suggests safer therapeutic options, when they exist.
Prescrire's review of drugs to avoid in order to provide better-quality care also serves as a solid base for certain analyses. For example, Australian academics used Prescrire's drugs to avoid to analyse the authorised drugs on the Australian market in 2019 (Prescrire Int n° 254). Our review also made it possible to easily identify drugs that did not warrant their place on the list of “essential” drugs, published by France's Ministry of Health in mid-2023 (Rev Prescrire n° 478).
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Main changes in the 2024 update of Prescrire's drugs to avoid
 Teriflunomide back among Prescrire's drugs to avoid
Teriflunomide is an immunosuppressant authorised for use in multiple sclerosis. It was removed from Prescrire's drugs to avoid while we evaluated its harm-benefit balance in a new indication: children aged 10 years or older. Analysis of the clinical evaluation data showed that teriflunomide's harm-benefit balance is also unfavourable in children. It is therefore back among Prescrire's drugs to avoid in order to provide better-quality care.
Three drugs no longer among Prescrire's drugs to avoid: fenfluramine, pholcodine and tixocortol mouth spray
Fenfluramine is an amphetamine that no longer features among Prescrire's drugs to avoid while we evaluate its harm-benefit balance in a new authorised indication, Lennox-Gastaut syndrome in children. It should still be avoided as an add-on to antiepileptic therapy in Dravet syndrome, a rare and serious form of infantile epilepsy (Prescrire Int n° 233).
Two drugs are no longer flagged as drugs to avoid because they are no longer marketed in France (nor in Belgium or Switzerland) and have not been granted marketing authorisation elsewhere in Europe through the centralised procedure: pholcodine, an opioid used as a cough suppressant; and tixocortol mouth spray, a corticosteroid used in combination with chlorhexidine for sore throat.
Idebenone's removal upheld following reassessment in 2023
Idebenone, a coenzyme Q10 analogue, claimed to act as an antioxidant, already no longer featured among Prescrire's drugs to avoid in 2023, because we were reassessing its harm-benefit balance in Leber hereditary optic neuropathy in light of the new data that had become available. Following this reassessment in 2023, Prescrire concluded that its harm-benefit balance was uncertain rather than unfavourable. These new, low-quality data suggest that idebenone slightly increases the number of patients whose visual acuity improves or stabilises, at a cost of the risk of serious hepatic adverse effects (Prescrire Int n° 251). Idebenone's removal is therefore upheld.
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> OPEN ACCESS "Towards better patient care: drugs to avoid in 2024" Prescrire Int 2024; 33 (256): 50-1 - 50-11.
For more about this year's update:
- Drugs to avoid in the name of better patient care: 2024 update > HERE
- Drugs to avoid: a reliable, rigorous, independent analysis > HERE
©Prescrire 1 February 2024
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