Towards better patient care: drugs to avoid in 2014

In order to help healthcare professionals and patients choose high-quality treatments and avoid harms, we have updated our list of drugs to avoid in early 2014. Prescrire's assessments of the harm-benefit balance of new drugs and indications are based on a rigorous procedure that includes a systematic and reproducible literature search, identification of patient-relevant outcomes, prioritisation of the supporting evidence, based on the strength of evidence, comparison with standard treatments; and an analysis of both known and potential adverse effects. Our 2014 review concerns drugs analysed in these pages over a four-year period, from 2010 to 2013. We identified 68 drugs that are potentially more harmful than beneficial in all of their authorised indications. In most cases, other drugs with a better harm-benefit balance are available. In other cases, there is no satisfactory alternative treatment. However, even for serious diseases, this does not justify exposing patients to serious risks when a drug has no proven efficacy. Some drugs can be used within the context of clinical trials, as long as patients enrolled in such studies are informed that the harms and benefits are uncertain and that this is precisely why they are being asked to participate in clinical research. Tailored supportive care is the best option when there are no available treatments capable of improving the prognosis, beyond the placebo effect.