Quek Hui Wen, Page Amy, Lee Kenneth, Lee Georgie, Hawthorne Deborah, Clifford Rhonda, Potter Kathleen, Etherton-Beer Christopher
School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia.
Ryman Healthcare, Christchurch, New Zealand.
Br J Clin Pharmacol. 2024 Oct;90(10):2409-2482. doi: 10.1111/bcp.16200. Epub 2024 Aug 20.
Previous systematic reviews suggest that deprescribing may improve survival, particularly in frail older people. Evidence is rapidly accumulating, suggesting a need for an updated review of the literature.
We updated a 2016 systematic review and meta-analysis to include studies published from inception to 26 April 2024 from specified databases. Studies in which older people had at least one medication deprescribed were included and grouped by study designs and targeted medications. The risk of bias was assessed using the Cochrane tool and the Newcastle-Ottawa tool. Odds ratios (OR) or mean differences were calculated as the effect measures using either the Mantel-Haenszel or generic inverse-variance method with fixed- or random-effects meta-analyses. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, physical health, cognitive function, quality of life and effect on medication regimen. Subgroup analyses were performed based on age and intervention types.
A total of 259 studies (reported in 286 papers) were included in this updated review. Deprescribing polypharmacy did not result in a significant reduction in mortality in both randomized (OR 0.96, 95% confidence interval [CI] 0.84-1.09) and non-randomized studies (OR 0.70, 95% CI 0.36-1.38). Further subgroup analyses of randomized studies on deprescribing polypharmacy demonstrated a significant reduction in mortality in the young old (aged 65-79) (OR 0.71, 95% CI 0.51-0.99) and when patient-specific interventions were applied (OR 0.79, 95% CI 0.63-0.99).
Deprescribing can be achieved with potentially important benefits in terms of improved survival, particularly when patient-specific interventions are applied and initiated early in the young old.
以往的系统评价表明，减药可能会提高生存率，尤其是在体弱的老年人中。证据正在迅速积累，这表明需要对文献进行更新综述。
我们更新了2016年的系统评价和荟萃分析，纳入了从数据库建立到2024年4月26日发表的研究。纳入了老年人至少有一种药物被减用的研究，并按研究设计和目标药物进行分组。使用Cochrane工具和纽卡斯尔-渥太华工具评估偏倚风险。使用Mantel-Haenszel或通用逆方差方法，通过固定效应或随机效应荟萃分析计算比值比（OR）或均值差作为效应量。主要结局是死亡率。次要结局是药物撤药不良事件、身体健康、认知功能、生活质量以及对药物治疗方案的影响。根据年龄和干预类型进行亚组分析。
本次更新综述共纳入259项研究（发表在286篇论文中）。在随机研究（OR 0.96，95%置信区间[CI] 0.84 - 1.09）和非随机研究（OR 0.70，95% CI 0.36 - 1.38）中，减少多重用药均未显著降低死亡率。对减少多重用药的随机研究进行进一步亚组分析表明，年轻老年人（65 - 79岁）（OR 0.71，95% CI 0.51 - 0.99）以及采用针对患者的干预措施时（OR 0.79，95% CI 0.63 - 0.99）死亡率显著降低。
减药可以实现，在提高生存率方面可能具有重要益处，尤其是在年轻老年人中早期应用针对患者的干预措施时。
