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Drugs to avoid

in the name of better patient care - 2021 update


The result of a reilable, rigourous and independent methodology 

 

Drugs to avoid: main changes in the 2021 update

Drugs to avoid What are the main differences between the 2020 and 2021 versions? Learn more...


Prescrire updates its review of drugs to avoid every year. As a result, some drugs are added to the list, while updates its review of drugs to avoid every year. others are removed, either because the pharmaceutical company or a health authority decided to withdraw the drug from the market, or pending the outcome of our reassessment of the drug's harm-benefit balance, which may change in light of new data. Below we outline the main differences between the 2020 and 2021 lists of drugs to avoid.

Gliflozins once again on the list of drugs to avoid in diabetes; addition of finasteride 1 mg, piracetam, esketamine, etc. to the 2021 update

Gaspard BilanGliflozins back on the list of drugs to avoid in diabetes

Glucose-lowering drugs belonging to the gliflozin class have been authorised for type 2 diabetes in the European Union since the mid-2010s. Increasing evidence of their unfavourable harm-benefit balance has accrued over time (Prescrire Int n° 160). Those currently marketed in Europe are :

  • canagliflozin (alone or combined with metformin)
  • dapagliflozin (alone or combined with metformin or saxagliptin)
  • empagliflozin (alone or combined with metformin or linagliptin)
  • ertugliflozin (alone or combined with metformin or sitagliptin).

Gliflozins were included in our 2019 list of drugs to avoid. They were removed in 2020 while we evaluated the harm-benefit balance of dapagliflozin in type 1 diabetes. Dapagliflozin has no more place in the treatment of type 1 diabetes than in type 2 diabetes. Following this re-evaluation, the gliflozin class of glucose-lowering drugs was reinstated on Prescrire's list of drugs to avoid.

Gaspard BilanNew drugs to avoid: finasteride 1 mg, piracetam, esketamine, etc.

Two drugs were added to our 2021 list of drugs to avoid because their adverse effects are disproportionate when weighed against their weak efficacy or the benign condition for which they are authorised. They are finasteride 1 mg, authorised for use in men with male-pattern baldness, and the "vasodilator" piracetam, authorised for various clinical situations including vertigo and cognitive impairment.

Three other drugs have some efficacy, but their adverse effects are disproportionate or other, less dangerous options exist: esketamine nasal spray in "treatment-resistant" depression; pimecrolimus in atopic eczema; and romosozumab in severe postmenopausal osteoporosis.

Meloxicam joins the other nonsteroidal anti-inflammatory drugs (NSAIDs) on our list that belong to the oxicam class: piroxicam and tenoxicam. Its omission from last year's review was simply an oversight.

Gaspard BilanSee : A reliable, rigorous and independent methodology > HERE

Three drugs removed from the list of drugs to avoid

In 2019, we added ulipristal 5 mg (Esmya°) to the list of drugs to avoid, because this antagonist and partial agonist of progesterone receptors, used for uterine fibroids, can cause serious liver injury, sometimes requiring liver transplantation (Prescrire Int n° 198; Rev Prescrire n° 418) (a). Esmya°'s marketing authorisation was suspended in the European Union in March 2020 due to these serious hepatic effects, and in September 2020, the European Pharmacovigilance Risk Assessment Committee (PRAC) recommended withdrawal of its marketing authorisation.

The intestinal "anti-infective" agent nifuroxazide was also removed from our list of drugs to avoid, because it is supposedly no longer marketed in France. This drug has no proven efficacy against diarrhoea, but it provokes serious, albeit rare, immune-mediated and haematological adverse effects.

We also removed the antiangiogenic tyrosine kinase inhibitor nintedanib from the list while we assess its harm-benefit balance in two new indications added in 2020: chronic fibrosing interstitial lung diseases with a progressive phenotype, and systemic sclerosis-associated interstitial lung disease. Nintedanib's harm-benefit balance remains unfavourable in the other situations for which it is authorised: idiopathic pulmonary fibrosis (Prescrire Int n° 173) and certain forms of non-small cell lung cancer (Rev Prescrire n° 389).

Note:
a - In postcoital contraception, ulipristal (still marketed under the brand name EllaOne°) is taken as a single 30 mg dose. Although it has not been shown to cause hepatitis when used in this way, levonorgestrel is a more cautious choice, especially since interactions between ulipristal and hormonal contraceptives can reduce the efficacy of ulipristal or the contraceptive (Prescrire Int n° 198 and n° 212) 

Drugs to avoid in 2020

 > FREE PDF  "Towards better patient care: drugs to avoid in 2021" Prescrire Int 2021; 30 (223): 51-1 - 51-11.

For more about this year's update:

  • Drugs to avoid in the name of better patient care: 2021 update > HERE
     
  • Drugs to avoid: a reliable, rigorous and independent methodology > HERE
©Prescrire 1 February 2021

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