How successful is deprescribing? Some new food for thought.

A systematic review evaluating the outcome of deprescribing compared with standard care has recently been promulgated. The subject in the included studies were adults 18 years and older who were not terminally ill. The primary outcome was successful deprescribing, defined as a statistically significant reduction in medication burden between the intervention group and the standard care or control group, or when more than 50% of intervention subjects were able to tolerate medication discontinuation compared with control by the end of the study. The most successful interventions used pharmacist-led educational interventions and patient-specific drug recommendations. Cardiovascular drugs including antihypertensives/diuretics and nitrates were the categories where deprescribing was most successfully attained, whereas there was less success with psychotropic medications and proton-pump inhibitors. The researchers point out that the results of the review also suggest that deprescribing may not necessarily not lead to expected outcomes such as lower falls rates, better cognition, improved quality of life, or a lower hospital admission rate; and may be associated with unexpected adverse outcomes on quality of life. Food for thought, given the current fervor for this potentially difficult to achieve outcome, which may require the application of considerable resources.