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; analysis of data on patient-relevant outcomes; prioritisation of the highest-level evidence; comparison with standard treatment, if one exists; and appraisal of the drug's known, foreseeable and suspected adverse effects.

Our 2025 review of drugs to avoid covers all the drugs examined by Prescrire between 2010 and 2024 that are authorised in the European Union or in France. It consists of 106 drugs that are more harmful than beneficial in all their approved indications.

For the patients concerned, when drug therapy appears to be the best course of action, other options with a better harm-benefit balance are available. And in some situations, the most prudent option is to forgo drug therapy.

Even when seriously ill patients have exhausted all other treatment options, there is no justification for exposing them to drugs with serious adverse effects when they have not been shown to improve their prognosis or quality of life. It may be acceptable to test such drugs in clinical trials, provided that the patients concerned are made fully aware of the uncertainties surrounding the drug's harm-benefit balance and the reasons for its continued evaluation, through discussions tailored to the patient's level of understanding. When such patients choose not to take part in a clinical trial, appropriate support and symptomatic care are called for, to mitigate the absence of any effective drug-based options.

For more about this year's update:
Drugs to avoid: a reliable, rigorous, independent analysis  HERE

Drugs to avoid: main changes in the 2025 update  HERE

 ©Prescrire 1 February 2025

Source: "Towards better patient care: drugs to avoid in 2025" Prescrire Int 2025; 34 (267): 52-1 - 52-11. FREE.