Towards better patient care: drugs to avoid in 2017

To help healthcare professionals and patients choose high-quality treatments that minimise the risk of adverse effects, in early 2017 we updated the list of drugs that Prescrire advises health pro- fessionals and patients to avoid. Prescire'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 fifth annual review of drugs to avoid has been extended to cover all drugs examined by Prescrire between 2010 and 2016 and authorised in the European Union, whereas previous reviews only considered drugs marketed in France. We iden- tified 91 drugs that are more harmful than beneficial in all the indications for which they have been authorised in France or in the European Union. 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 their placebo effect.