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

Abstract

BackgroundPolypharmacy 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.AimTo examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes.Design and settingThis systematic review included randomised controlled trials published in 2005–2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing.MethodPubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication.ResultsA total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years 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%.ConclusionOnly a few studies have examined 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 seem 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.

Efficacy of adding ramipril (VAsotop) to the combination of furosemide (Lasix) and pimobendan (VEtmedin) in dogs with mitral valve degeneration: TheVALVEtrial

“…Also, withdrawal of ACEI from dogs in the DT that had received an ACEI before entry into the study, or the switching of the prescribed ACEI to ramipril in the TT group, might be a limitation. The withdrawal of a long-term prescribed drug might have a detrimental effect for the patient, 25 but in our study, this primarily would have affected the DT group suffering potentially from drug withdrawal, whereas the switching to another ACEI product is most likely less problematic.…”

Barriers and facilitators to deprescribing in primary care: a systematic review

“…Care for patients with multimorbidity and polypharmacy predominantly takes place in primary care, with the GP undertaking a crucial role in managing patients’ medication. 8 , 28 Despite the development of safe deprescribing interventions, uncertainty remains as to their effectiveness, and to the factors that may influence their implementation. 3 , 7 , 12 This is particularly evident in primary care, where there is no consistent approach to deprescribing.…”

The Romanian Society of Internal Medicine’s Choosing Wisely Campaign

“…In elderly patients, data from nonrandomized studies suggest that deprescribing reduces mortality and results of randomized trials correlate mortality reduction with patient-specific deprescribing interventions [14]. Both in the hospital [11] as well as in the primary care setting [15], tailored interventions for deprescribing and tapered cessation of medication seem safe and effective. STOPP/START criteria for potentially inappropriate prescribing in older patients [16] may be effective in improving the quality of polypharmacy especially in elderly, frail adults [17].…”