Background The principles of deprescribing (the process of tapering, withdrawing, discontinuing or stopping medicines) arise from appropriateness methods (Beers and STOPP criteria). They include reviewing all current medicines and identifying medicines to be withdrawn, substituted or reduced. Considering the high pill burden for patients with several comorbidities, such patients might benefit from a systematic approach to deprescribing.
Purpose To identify the available evidence about deprescribing strategies in the elderly and/or patients with several chronic conditions and, if applicable, assess its efficacy.
Materials and methods Systematic review of studies published from 1967–2013 in MEDLINE and EMBASE. Eligible studies had to report the success rate [SR] of deprescribing strategies. Success was defined as not having to modify further the withdrawn, substituted or reduced drug during the study follow-up. The search strategy included terms for deprescribing (drug withdrawal, appropriateness), study population (polypathological [PP], chronic disease, elderly) and study design (clinical trial [CT], observational study[OS]).
Results Seventy-two articles were examined. Twenty of them (14 CTs, 6 OSs) fulfilled all inclusion criteria. None focused on PP patients. Several of them focused on benzodiazepines 5(30%), diuretics 2(10%) and antihypertensive drugs 2(10%). Strategies based on a full pharmacotherapy review conducted by pharmacists or physicians (5 studies) showed a 70% SR. They were based on clinical practice or explicit methods (Beers or STOPP-criteria). In contrast, the SR for single drug class strategies (15 studies) was 30%. Furthermore, the SR was higher in CTs (80%) than Oss (20%). Health outcomes were collected in all the studies but did not show a statistically significant improvement across all the intervention groups.
Conclusions Currently there is no evidence of the benefit of deprescribing on PP. Interventions in patients with chronic conditions and the elderly seems more effective if a full pharmacotherapy review done by pharmacists or physicians in the context of a CT. There is no current evidence of efficacy from systematic interventions based on software programs or similar tools.
No conflict of interest.
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