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NP-004 a new database on the off-label use of drugs in palliative medicine
  1. SP Stefanie Pügge,
  2. ADO Aleksandra Dukic-Ott,
  3. SB Stephanie Büsel,
  4. JB Julian Baumgärtel,
  5. CR Constanze Rémi
  1. Department of Palliative Medicine, University Hospital, LMU Munich, Germany


Background and Importance The main focus of palliative care (PC) is the relief of distressing symptoms. Up to 50% of drugs are used off-label (OLU); yet only a limited part of these uses is supported by official recommendations such as guidelines.

The efficient search for evidence-based information is therefore particularly important for treatment planning. However, in everyday clinical practice, health care professionals often lack the time and resources for such research.

Aim and Objectives The aim is to provide healthcare professionals with evidence-based therapy recommendations for OLU in palliative care through the database

Materials and Methods Relevant drugs and their OLU in PC are identified using a systematic approach. Treatment recommendations are subsequently developed based on the best available evidence and agreed through a web-based, two-round Delphi panel process with international PC experts. The final off-label treatment recommendations are presented in drug monographs and include additional information, e.g. on monitoring or alternative medical and non-medical treatment options.

Results The first 38 treatment recommendations were agreed upon in 2022. 70 experts participated in each round (response rate: first round 72.9%/second round 67.9%). Since 2023 recommendations are accessible free of charge on In total, the aim is to publish around 400 treatment recommendations for around 80 drugs. A smartphone app is under development.

Conclusion and Relevance provides easy access to evidence-based information. The database fills an information gap and makes an important contribution to safe and effective pharmacotherapy in PC.

Funding German cancer aid (Fördernr. 70113910).

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