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 if discontinuation can be done successfully without an increased risk of a return of symptoms, or an event, or need to restart as 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 if 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 one 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 9 remaining reviews used frequency of symptomatic relapse, 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, and with variation in definition. The results support a broader discussion with involvement of patients and clinicians on primary outcomes and how successfully discontinuation need to be defined in deprescribing Cochrane reviews.
Patient, public and/or healthcare consumer involvement: need to be involved in the broader discussion