Deprescribing: An umbrella review

This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limit...

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Bibliographic Details
Published in:Acta pharmaceutica (Zagreb, Croatia) Croatia), 2024-06, Vol.74 (2), p.249-267
Main Authors: Japelj, Nuša, Horvat, Nejc, Knez, Lea, Kos, Mitja
Format: Article
Language:English
Subjects:
Clinical trials
deprescription
Deprescriptions
drug discontinuation
drug tapering
drug withdrawal
Drug-Related Side Effects and Adverse Reactions - prevention & control
Drugs
Humans
Inappropriate Prescribing - prevention & control
Intervention
Optimization
Patients
Polypharmacy
Systematic Reviews as Topic
umbrella review
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Summary:This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with . Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.
ISSN:1846-9558
1330-0075
1846-9558
DOI:10.2478/acph-2024-0011