Room for improvement in reporting of trials discontinuing long-term medication: a systematic review.

BACKGROUND AND OBJECTIVE: Discontinuation of inappropriate medication is widely recognized as an essential component of best prescribing practice. Physicians typically attempt to taper or stop medications on the basis of clinical experience, rather than using a systematic approach guided by evidence. We sought to evaluate if the reporting of deprescribing trials conducted in primary care is of sufficient quality and detail to allow replication in clinical practice. METHODS: This study presents a secondary analysis of data from a systematic review published in 2018, investigating the effects of discontinuation of chronic medication in primary care. Twenty-six publications reporting on 27 trials were included. The quality of reporting was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS: No study provided complete reporting on all TIDieR items. All studies provided a clear description and rationale for the intervention; however, details of the intervention were insufficiently reported in most studies, with high variability between studies. Consultation of secondary sources resulted in minimal additional information. CONCLUSIONS: There are significant deficits in reporting methodological details of deprescribing interventions in primary care. It is likely that evidence-based deprescribing is not being implemented as routinely into health-care practice as it could be. Increasing the quality of intervention reporting is essential to avoid wastage of research resources and ought to be a focus for all discontinuation trials.

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

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, that is, primary care (or general practice) and nursing homes. DESIGN AND SETTING: This 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. METHOD: PubMed 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. RESULTS: A 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%. CONCLUSION: Only 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.