Capturing the primary outcome for Cochrane reviews of deprescribing specific medications: an overview of Cochrane reviews
2Faculty of Medicine, University of British Columbia, Canada
3University of Sydney School of Pharmacy, Australia
5University of South Australia, Australia
6University of Queensland, Australia
Deprescribing is the process of discontinuing an inappropriate medication. Research into deprescribing has grown rapidly in recent years, including a number of Cochrane systematic reviews (CR). It is important to study whether discontinuation can be done successfully without an increased risk of a return of symptoms, an event, or need to restart because this is important for clinicians and patients. In this review, we want to review primary outcomes in deprescribing CR.
Objectives: To review reported primary outcomes in CR of deprescribing specific medications and to assess which CR included successful discontinuation rate and how this is defined. We also aimed to assess whether CR reported the proportion of patients who successfully stopped, frequency of relapse or event, and of restarting medication as primary outcome.
Methods: We screened all published CR in the Cochrane Database of Systematic reviews until February 2023. Reviews were included if they aimed to assess discontinuing a specific medication (classes) or interventions to support discontinuing medication. We extracted all primary outcomes.
Results: We included 14 CR related to deprescribing (9 CR assessing discontinuation of 1 medication such as cholinesterase-inhibitors, or antipsychotics in dementia, and 5 CR of interventions for discontinuing medication such as approaches to stop antidepressant and interventions for the reduction of prescribed opioid use in chronic pain). All included more than one primary outcome, which resulted in a variety of primary outcomes. Four (29%) reviews used a primary outcome related to ‘successful discontinuation rate’, e.g., the number of patients who successfully stopped the specific medication; however, studies varied in the definition of successful discontinuation. The nine remaining reviews used frequency of symptomatic relapse or occurrence of a medical event as the primary outcome.
Conclusions: A broad range of primary outcomes was reported in CR of deprescribing medication. A few CR have examined successful discontinuation rate, with variation in definition. The results support a broader discussion with involvement of patients and clinicians on primary outcomes and how successfully discontinuation needs to be defined in deprescribing Cochrane reviews. Patient, public, and/or healthcare consumer involvement: Need to be involved in the broader discussion.