Abstract

• Prescrire's assessment of a drug's harm­-benefit balance in a given situation reflects a rigorous procedure based on: a systematic and reproducible literature search; patient-relevant outcomes; prioritisation of the supporting data according to strength of evidence; comparison with standard treatment (if one exists); weigh­ing the adverse effects, taking into account any uncertainties and gaps in our knowledge.
   
• This annual review of drugs to avoid covers all the drugs examined by Prescrire between 2010 and 2021 that are authorised in the Euro­pean Union or in France. We have identified 105 drugs that are more harmful than benefi­cial in all their approved indications.
   
• In most cases, 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.
  
  
• For patients with a serious condition, who have exhausted all other treatment options, there is no justification for exposing them to drugs with severe adverse effects but no proven efficacy. It is sometimes acceptable to test these drugs in clinical trials, provided that patients are made fully aware of the uncertain­ ties surrounding the drugs' harm­-benefit bal­ance, as well as the trial's objectives, in discus­sions tailored to the patient's level of understanding. For patients who 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 treatments which could improve their prog­nosis or quality of life.

©Prescrire 1 February 2022

Source: "Towards better patient care: drugs to avoid in 2022" Prescrire International 2022; 31 (234): 50-1 - 50-10. Free.

Download the full article