Main differences between the 2022 and 2023 lists of drugs to avoid

Three more drug to avoid: peanut protein, roxadustat and opium tincture

These drugs were added to our 2023 list of drugs to avoid because their adverse effects are disproportionate to any efficacy they might have.

Powdered peanut seed, containing peanut protein (Palforzia°), taken orally to desensitise patients with peanut allergy, reduced the incidence and intensity of allergic reactions to peanuts in a test conducted in hospital. However, it increases the incidence of allergic reactions in patients' everyday life, including reactions that require adrenaline administration.

Roxadustat (Evrenzo°), authorised for use in anaemia associated with chronic kidney disease, is no more effective at correcting anaemia than epoetins, overall.
Yet it appears to increase mortality in some patients and has a more burdensome adverse effect profile.

Opium tincture (marketed in France under the brand name Dropizal°), a "soup" containing a variety of constituents of the poppy Papaver somniferum L., has been authorised for use in severe diarrhoea. Yet it offers no clinical advantages over loperamide, an opioid marketed alone in this situation.

Nintedanib back on the list of drugs to avoid

Nintedanib is a tyrosine kinase inhibitor with an anti-angiogenic effect, authorised for use in certain types of non-small cell lung cancer (under the brand name Vargatef°) and certain chronic lung conditions (under the brand name Ofev°). It was removed from our list of drugs to avoid in 2020 while we reassessed its harm-benefit balance in some new indications: certain types of pulmonary fibrosis and systemic sclerosis-associated interstitial lung disease. Analysis of the clinical evaluation data showed that nintedanib also has an unfavourable harm-benefit balance in these situations. It is therefore back on the list of drugs to avoid.

Two drugs removed from the list pending reassessment: idebenone and teriflunomide

Idebenone (Raxone°) was removed from the list of drugs to avoid while Prescrire reassesses its harm-benefit balance in Leber's hereditary optic neuropathy.

The immunosuppressant teriflunomide (Aubagio°), authorised for use in multiple sclerosis, has also been removed from the list because Prescrire is evaluating its harm-benefit balance in children aged 10 years and older, after its original indication was extended to include these patients.