atezolizumab

Score breakdown (76/100)

Safety: 83

• Death appears in 2.8x the share of reports seen across all of FAERS (-12)
• Off-label use is among the five most-reported items: widely used beyond its approved evidence (-5)

Evidence: 68

• 211 randomized trials and 34 systematic reviews/meta-analyses indexed in PubMed
• On the WHO Model List of Essential Medicines (shown for context; no score effect)
• No Cochrane review found (-5)

Regulatory history: 100

• No recalls on record since 2016

Money & lawsuits: 55

• Pharma paid doctors $49,937,905 tied to this drug last year (-45)
• Not named in any pending federal MDL

Options: 70

• No generic version approved: brand-only pricing (-30)
• 9 same-class alternatives exist

Independent reviews and post-approval warnings

WHO Essential Medicine

Listed on the WHO Model List of Essential Medicines: a global expert panel judged it among the medicines a health system should always have, on evidence of value, not marketing.

What the FDA label says

Approved uses

Not available.

Contraindications

None listed.

Source: FDA SPL label, effective .

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

Problems reported most often

Reports per year

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

Evidence base

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $49,937,905 in payments to US physicians and hospitals tied to this drug across 2,594 transactions (Tecentriq $49,937,905).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

Same-class alternatives

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

1. The most-reported problems in FDA's adverse event data are death, disease progression, pyrexia. How would we recognize and handle those?
2. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
3. Why this one over avelumab, cemiplimab, dostarlimab? What would make you pick one of those instead?
4. There is no generic. Is there an older generic in the same class that works as well for my situation?
5. The manufacturer pays physicians heavily to promote this drug. Have you received anything from them?
6. What result are we expecting, by when, and what is the plan if it does not happen?
7. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)