Towards better patient care: drugs to avoid in 2016

To help healthcare professionals and patients choose high-quality treatments that minimize the risk of adverse effects, in early 2016 we updated our list of drugs to avoid. 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 data based on the strength of evidence, comparison with standard treatments, and an analysis of both known and potential adverse effects. This 2016 review of medications examined by Prescrire over a six-year period, from 2010 to 2015, identified 74 drugs that are more harmful than beneficial in all the indications for which they have been authorised in France. In most cases, when drug therapy is really necessary, other drugs with a better harm-benefit balance are available. Even in serious situations, when no effective treatment exists, there is no justification for prescribing a drug with no proven efficacy that provokes severe adverse effects. It may be acceptable to test these drugs in clinical trials, but patients must be informed of the uncertainty over their harm-benefit balance, and the trial design must be relevant. Tailored supportive care is the best option when there are no available treatments capable of improving prognosis or quality of life, beyond the placebo effect.