• Prescrire's assessment of a drug's harm­-benefit balance in a given situation is underpinned by a rigorous procedure based on: a systematic and reproducible literature search; data on patient-relevant outcomes; prioritisation of the highest-level evidence; comparison with standard treatment (if one exists); and appraisal of the drug’s 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 2022 that are authorised in the Euro­pean Union or in France. It consists of 107 drugs that are more harmful than beneficial in all their approved indications.
   
• In most situations, 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.
   
• When seriously ill patients 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 uncertainties surrounding the drug’s harm-benefit balance, as well as the trial’s objectives, through 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 treatment options which could improve their prognosis or quality of life.

For more about this year's update:

Drugs to avoid: a reliable, rigorous and independent methodology > HERE

Drugs to avoid: main changes in the 2022 update > HERE

 ©Prescrire 1 February 2023

Source: "Towards better patient care: drugs to avoid in 2023" Prescrire International 2023; 32 (245): 50-1 - 50-11. Free.

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