Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Primary Care Clinical Unit, Faculty of Medicine, the University of Queensland, Brisbane, Australia.
Br J Gen Pract. 2018 Oct;68(675):e663-e672. doi: 10.3399/bjgp18X699041.
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.
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.
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.
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.
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%.
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.
多种药物治疗变得越来越普遍，评估药物使用的适当性变得越来越重要。初级保健医生通常会进行减药过程，但这存在几个障碍。
检查停止用药的可行性和安全性，重点关注在社区（即初级保健（或全科医学）和疗养院）进行的研究。
本系统评价纳入了 2005 年至 2017 年发表的随机对照试验，研究了在初级保健环境中停止长期处方药物的情况，并将继续用药与停药进行了比较。
进行了 PubMed 和 EMBASE 检索，提取的数据包括成功停止用药的患者人数和症状复发或重新开始用药的患者人数。
本综述共纳入 26 篇论文中的 27 项研究。研究参与者人数从 20 人到 2471 人不等，参与者的平均年龄从 50.3 岁到 89.2 岁不等。成功停止用药的患者比例从 20%到 100%不等，报告的复发率从 1.9%到 80%不等。
只有少数研究检查了初级保健中停止用药的成功率和安全性，这些研究非常异质。大多数研究表明，减药和停止长期使用似乎是安全的；然而，存在症状复发的风险。需要进一步研究，为医生在初级保健环境中做出基于证据的减药决策提供建议。
