Revisiting systematic reviews on deprescribing trials to better inform future practice and research

Spinewine, Anne; Reeve, Emily; Thompson, Wade

doi:10.1111/bcp.15864

Cited by 5 publications

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, it has been identified that many deprescribing reviews include studies where deprescribing is not the only focus of the intervention, often including the aim to prescribe appropriate medications or reduce initiation of inappropriate medications. This may dilute impact on other outcomes [ 82 ]. Deprescribing research would benefit from the selection and reporting of consistent outcomes and the development of a core outcome set specific to deprescribing [ 83 ].…”

Section: Discussionmentioning

confidence: 99%

Deprescribing interventions in older adults: An overview of systematic reviews

Chua,

Todd,

Reeve

et al. 2024

PLoS ONE

Self Cite

View full text Add to dashboard Cite

Objective The growing deprescribing field is challenged by a lack of consensus around evidence and knowledge gaps. The objective of this overview of systematic reviews was to summarize the review evidence for deprescribing interventions in older adults. Methods 11 databases were searched from 1st January 2005 to 16th March 2023 to identify systematic reviews. We summarized and synthesized the results in two steps. Step 1 summarized results reported by the included reviews (including meta-analyses). Step 2 involved a narrative synthesis of review results by outcome. Outcomes included medication-related outcomes (e.g., medication reduction, medication appropriateness) or twelve other outcomes (e.g., mortality, adverse events). We summarized outcomes according to subgroups (patient characteristics, intervention type and setting) when direct comparisons were available within the reviews. The quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). Results We retrieved 3,228 unique citations and assessed 135 full-text articles for eligibility. Forty-eight reviews (encompassing 17 meta-analyses) were included. Thirty-one of the 48 reviews had a general deprescribing focus, 16 focused on specific medication classes or therapeutic categories and one included both. Twelve of 17 reviews meta-analyzed medication-related outcomes (33 outcomes: 25 favored the intervention, 7 found no difference, 1 favored the comparison). The narrative synthesis indicated that most interventions resulted in some evidence of medication reduction while for other outcomes we found primarily no evidence of an effect. Results were mixed for adverse events and few reviews reported adverse drug withdrawal events. Limited information was available for people with dementia, frailty and multimorbidity. All but one review scored low or critically low on quality assessment. Conclusion Deprescribing interventions likely resulted in medication reduction but evidence on other outcomes, in particular relating to adverse events, or in vulnerable subgroups or settings was limited. Future research should focus on designing studies powered to examine harms, patient-reported outcomes, and effects on vulnerable subgroups. Systematic Review Registration PROSPERO CRD42020178860.

show abstract

Section: Discussionmentioning

confidence: 99%

Deprescribing interventions in older adults: An overview of systematic reviews

Chua,

Todd,

Reeve

et al. 2024

PLoS ONE

Self Cite

View full text Add to dashboard Cite

show abstract

“…Additionally, it has been identified that many deprescribing reviews include studies where deprescribing is not the only focus of the intervention, often including the aim to prescribe appropriate medications or reduce initiation of inappropriate medications. This may dilute impact on other outcomes [82]. Deprescribing research would benefit from the selection and reporting of consistent outcomes and the development of a core outcome set specific to deprescribing [83].…”

Section: Plos Onementioning

confidence: 99%

Untitled

View full text Add to dashboard Cite

When cardiovascular medicines should be discontinued

Krychtiuk,

Gersh,

Washam

et al. 2024

European Heart Journal

View full text Add to dashboard Cite

An integral component of the practice of medicine is focused on the initiation of medications, based on clinical practice guidelines and underlying trial evidence, which usually test the addition of novel medications intended for life-long use in short-term clinical trials. Much less attention is given to the question of medication discontinuation, especially after a lengthy period of treatment, during which patients age gets older and diseases may either progress or new diseases may emerge. Given the paucity of data, clinical practice guidelines offer little to no guidance on when and how to deprescribe cardiovascular medications. Such decisions are often left to the discretion of clinicians, who, together with their patients, express concern of potential adverse effects of medication discontinuation. Even in the absence of adverse effects, the continuation of medications without any proven effect may cause harm due to drug–drug interactions, the emergence of polypharmacy, and additional preventable spending to already strained health systems. Herein, several cardiovascular medications or medication classes are discussed that in the opinion of this author group should generally be discontinued, either for the prevention of potential harm, for a lack of benefit, or for the availability of better alternatives.

show abstract

Revisiting systematic reviews on deprescribing trials to better inform future practice and research

Cited by 5 publications

References 33 publications

Deprescribing interventions in older adults: An overview of systematic reviews

Deprescribing interventions in older adults: An overview of systematic reviews

Untitled

When cardiovascular medicines should be discontinued

Contact Info

Product

Resources

About