Abstract

• To make it easier to choose quality care, and to prevent disproportionate harms to patients, Prescrire has published its annual update of drugs to avoid.
   
• Prescrire's assessments of the harm-benefit balance of drugs in given situations are based on a rigorous procedure that includes a systematic and reproducible literature search, results based on 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.
   
• This annual review of drugs to avoid covers all the drugs examined by Prescrire between 2010 and 2018 that are authorised in the European Union or in France. We identified 93 drugs (82 of which are marketed in France) that are more harmful than beneficial in all the approved indications. 
   
• In most cases, when drug therapy is really necessary, other drugs with a better harm-benefit balance are available.
   
• 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 is sometimes acceptable to test these drugs in clinical trials, but patients must be informed of the uncertainty over their harm-benefit balance and of the trial's objectives. Tailored supportive care should be used when there are no effective treatments for improving prognosis or quality of life.
   
• For more information on this year's update, see
  • Drugs to avoid: main changes in the 2019 update and
  • Drugs to avoid in 2019: a reliable, rigorous and independent methodology

©Prescrire 1 April 2019

FREE "Towards better patient care: drugs to avoid in 2019" Prescrire Int 2019; 28 (203):
108-1 - 108-10. (Pdf, free).

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