Kamgang Karl-Hermann Sielinou, Lundby Carina, Szilcz Máté, Johnell Kristina, Wastesson Jonas W
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense M, Denmark.
Basic Clin Pharmacol Toxicol. 2025 Sep;137(3):e70093. doi: 10.1111/bcpt.70093.
National estimates of drug discontinuation for deprescribing targets in older adults are limited, partly due to challenges distinguishing planned deprescribing from poor adherence. Focusing on individuals with multidose dispensing (MDD), characterized by high adherence by design, may yield realistic discontinuation rates.
To estimate the rates of discontinuation for chronically used drugs targeted for deprescribing among older adults, and to describe reinitiation among users of MDD and standard dispensing (non-MDD).
In this nationwide cohort study, Swedish adults aged ≥ 75 were identified from national registers. At baseline (1 January 2021), chronic users of seven drug classes were defined. We estimated the 12-month cumulative incidence of discontinuation (defined as no new dispensing during the treatment episode of the prior dispensing plus a 180-day grace period) and the proportion of patients restarting therapy within 180 days after discontinuation.
We identified 162 518 chronic users: benzodiazepines (n = 69 511), PPIs (n = 43 973), antidepressants (n = 41 577), statins (n = 36 085), cholinesterase inhibitors (n = 6408), bisphosphonates (n = 5801) and antipsychotics (n = 4380). Discontinuation rates were low (8.3-51.5 per 1000 person-years), and non-MDD users had higher discontinuation and reinitiation rates across all drugs.
Discontinuation among Swedish older adults is infrequent. Irregular dispensing is likely misclassified as deprescribing, and MDD users may better reflect true discontinuation in routinely collected data.
关于老年人减药目标的全国性药物停用估计有限，部分原因是难以区分计划性减药和依从性差。关注多剂量配药（MDD）的个体，其特点是设计上依从性高，可能会得出实际的停药率。
估计老年人中针对减药目标的长期使用药物的停药率，并描述MDD使用者和标准配药（非MDD）使用者中的重新用药情况。
在这项全国性队列研究中，从国家登记册中识别出年龄≥75岁的瑞典成年人。在基线（2021年1月1日）时，确定了七类药物的长期使用者。我们估计了停药的12个月累积发生率（定义为在前一次配药的治疗期间加上180天宽限期内没有新的配药）以及停药后180天内重新开始治疗的患者比例。
我们识别出162518名长期使用者：苯二氮䓬类药物（n = 69511）、质子泵抑制剂（n = 43973）、抗抑郁药（n = 41577）、他汀类药物（n = 36085）、胆碱酯酶抑制剂（n = 6408）、双膦酸盐类药物（n = 5801）和抗精神病药物（n = 4380）。停药率较低（每1000人年8.3 - 51.5），并且在所有药物中，非MDD使用者的停药和重新用药率更高。
瑞典老年人中停药情况不常见。不规则配药可能被错误分类为减药，并且MDD使用者可能在常规收集的数据中更好地反映真正的停药情况。
