A systematic review of deprescribing trials

Effect of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials

Sioe Lie Thio, Joana Nam, Mieke van Driel, Thomas Dirven, Jeanet Blom

De abstractcommissie heeft op verzoek van de congrescommissie 6 abstracts geselecteerd die tijdens het Verenso najaarscongres 'Oud en benauwd' op 29 november 2018 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Background

Polypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process. However, there are several barriers to implementing this.  

Aim

To examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, i.e. primary care (or general practice) and nursing homes.

Design and Setting

This is a systematic review including randomized controlled trials published in 2005-2017, that studied withdrawal of long-term drugs prescribed in primary care settings and comparing continuing medication with discontinuing.

Method

We conducted a PubMed and Embase search. Extracted data included: number of patients who successfully stopped medication and number of patients who experienced relapse of symptoms or restarted medication.  

Results

A total of 27 studies reported in 26 papers were included in our review. The number of participants in the studies varied from 20 to 2471. The mean age of participants ranged from 52.7 to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100% and the range of reported relapse varied from 1.9% to 80%.

Conclusion

Only few studies have studied the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seems safe, however there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence based decisions about deprescribing in primary care settings.