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Towards better patient care: drugs to avoid in 2020

T his is Prescrire ’s eighth consecutive annual review of drugs to avoid, which includes docu- mented cases of drugs that are more danger- ous than beneficial (1,2). The aim is to make it easier to choose safe, effective treatments, primar- ily to avoid exposing patients to unacceptable harms. The drugs listed (sometimes a particular form or dose strength) should be avoided in all the clinical situations for which they are authorised in France or in the European Union. A reliable, rigorous and independent methodology What data sources and methodology do we use to assess a drug’s harm-benefit balance? Our list of drugs to avoid concerns drugs and indications on which we published detailed analyses in our French edition over the 10-year period from 2010 through 2019 inclusive. Some drugs and indi- cations were examined for the first time, while others were re-evaluated as new data on efficacy or adverse effects have become available. One of the main objectives of our publications is to provide health professionals (and thereby their patients) with the clear, independent, reliable and up-to-date information they need, free from conflicts of interest and commercial pressures. Prescrire is structured in such a way as to guarantee the quality of the information provided to our sub- scribers. The Editorial Staff comprise a broad range of health professionals working in various sectors and free from conflicts of interest. We also call on an extensive network of external reviewers (specialists in the relevant area, methodologists, and practitioners representative of our readership), and each article undergoes multiple quality controls and cross- checking at each step of the editorial process (see About Prescrire > How we work at english.prescrire.org)

ABSTRACT

● To make it easier to choose quality care, and to prevent disproportionate harm to patients, Prescrire has published its annual update of drugs to avoid. ● Prescrire ’s assessments of the harm-benefit bal- ance of drugs in given situations are based on a rig- orous procedure involving a systematic and repro- ducible literature search, results based on patient-relevant outcomes, prioritisation of the sup- porting data based on the strength of evidence, com- parison with standard treatment (if one exists), and taking into account known and potential adverse effects, as well as the uncertainties surrounding them. ● This annual review of drugs to avoid covers all the drugs examined by Prescrire between 2010 and 2019 that are authorised in the European Union or in France.We identified 105 drugs (92 of which are marketed in France) 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. ● Even if a patient has a serious condition for which no effective treatment exists, there is no justifica- tion for prescribing a drug with no proven efficacy that provokes severe adverse effects. It is some- times acceptable to test these drugs in clinical trials, but patients must be informed of the uncer- tainties over their harm-benefit balance as well as the trial’s objectives. If this option is not chosen, appropriate support and symptomatic care should be implemented when there are no effective treat- ments for improving the prognosis or quality of life. Rev Prescrire 2019; 39 (434): 931-942

P age 18 • P rescrire I nternational S pecial E dition 2020