Must the risk of side effects dictate pharmacological practices?

Abstract

Objectives:Recently, the SOHO, CATIE and CUTLASS studies showed that molecules which apparently showed the most side effects are not only the most effective but also tend to cause to the least frequent changes in treatment. Can we generalise this assertion ?Method:Review of the literature addressing comparing efficiency of treatments and cost efficacy studies. Result: Although we witness a profusion of publications about the efficiency of given molecules vs placebo, studies comparing molecules are scarce, and studies on cost efficacy in natural environments are even scarcer. The last few years’ efforts to completely minimise side effects seem to have resulted in a reduction of medication efficacy. Moreover, the previously held hypothesis suggesting that the fewer the side effects, the less the need to change treatment has been proven wrong. The duration of a treatment is more dependent upon its efficiency.Conclusion:Clinicians cannot use the absence of noxiousness of a molecule as their primary criterion of choice. They should carefully balance side effects and efficiency. There is a lack of studies about cost-efficacy and, in the interpretation of such studies it is essential that the limitations of the studies be taken into account, and their results should not be over-generalised. There is a danger that such misinterpretation of results may lead us to abandon the use of some of our most effective molecules, even though the data actually favours the use of Effective drugs with the appropriate monitoring of and dealing with side effects.