Reduction of inappropriate and futile pharmacotherapy – deprescribing

Česká verzia

Authors: E. Topinková
Authors place of work: Geriatrická klinika 1. LF UK a VFN Praha
Published in the journal: Geriatrie a Gerontologie 2020, 9, č. 1: 9-14
Category: Review Article

Summary

In the last two decades the number of drugs prescribed to the elderly is increasing steadilly. Polypharmacy, despite being beneficial in the treatment of multimorbid patients,confers also a risk such as drug-drug interactions, adverse drug events, inappropriate drug prescription, higher level of frailty and increased mortality in some studies. Critical appraisal of prescribed and used medications is an integral part of daily clinical practice of the geriatrician.A novel term in geriatric pharmacotherapy is „deprescribing“ defined as a systematic reduction or withdrawal of drugs for which there is no indication, which are inappropriate in older patients or specifically in individual patient, drug duplicities and all other drugs which do not reflect treatment goals and patient´s values and preferences.In the review article, for the first time in the Czech literature, the deprescribing process and recommended tools are discussed and the algorhithm for deprescribing of PPI presented as an example.

Keywords:

polypharmacy – Beers criteria 2019

Zdroje

1. Kaufman DW, et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 2002;287(3):337–344.

2. Onder G, Bonassi S, Abbatecola AM, et al. High prevalence of poor quality drug prescribing in older individuals: a nation wide report from the Italian Medicines Agency (AIFA). J Gerontol A Biol Sci Med Sci 2014;69(4):430–437.

3. Fialová D, Topinková E, Ballóková A, et al. Expertní konsenzus ČR 2012 v oblasti léčiv a lékových postupů potenciálně nevhodných ve stáří. Klin Farmakol Farm 2013; 27(1): 18–28.

4. Ústav lékového průvodce, projekt senior 2016:https://www.lekovypruvodce.cz/cs/seniori-v-domovech-jsou-casto-ohrozeni-nevhodnymi-leky

5. Thomsen LA, et al. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharmacother 2007;41(9):1411–1426.

6. Topinkova E. Aging, disability and frailty. Ann Nutr Metab 2008;52(Suppl. 1): 6–11.

7. Mangin D, Bahat G, Golomb BA, et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action. Drugs Aging 2018; 35: 575–587.

8. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014;13(1):57–65.

9. Kameníková L, Farghal H. Problematika polypragmazie, polymorbidity, adherence a compliance. Zdravotnictví a medicína 2014;18:25. Dostupné z: https://zdravi.euro.cz/clanek/problematika-polypragmazie-polymorbidity-adherence-a-compliance-477303

10. Woodward MC. Deprescribing: achieving better health outcomes for older people through reducing medications. J Pharm Pract Res 2003;33: 323–328.

11. Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging definition of ,deprescribing‘ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol 2015;80(6): 1254–1268.

12. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 2015;175(5): 827–834.

13. Machado-Alba JE, Gaviria-Mendoza A, Machado-Duque ME, Chica L. Deprescribing: a new goal focused on the patient. Expert Opin Drug Saf 2017;16(2): 111–112.

14. Denholm R, Morris R, Payne R. Polypharmacy patterns in the last year of life in patients with dementia. Eur J Clin Pharmacol 2019;75(11):1583–1591.

15. Colloca G, Tosato M, Topinkova E, et al; Inappropriate drugs in elderly patients with severe cognitive impairment: results from the Shelter study. PLoS One 2012;7(10): e46669.

16. 2019 American Geriatrics Society Beers CriteriaUpdate Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67(4): 674–694.

17. Reeve E, Moriarty F, Nahas R, et al. A narrative review of the safety concerns of deprescribing in older adults and strategies to mitigate potential harms.Expert Opin Drug Saf 2018;17(1): 39–49.

18. Linsky A, Meterko M, Stolzmann K, Simon SR. Supporting medication discontinuation: provider preferences for interventions to facilitate deprescribing. BMC Health Serv Res 2017; 7(1): 447.

19. Reeve E, et al. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc 2013;61(9): 1508–1514.

20. Tannenbaum C, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med 2014;174(6): 890–898.

21. Thompson W, Lundby C, Graabæk T, et al. Tools for deprescribing in frail older persons and those with limited life expectancy. A systematic review. J Am Geriatr Soc 2019; 67(1): 172–180.

22. Reeve E, Thompson W, Farrell B. Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. Eur J Intern Med 2017;38: 3–11.

23. Lavan A, Gallagher P, Parsons C, et al. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): Consensus validation. Age Ageing 2016;45: 1–12.

24. Rodriguez-Pérez A, Alfaro-Lara ER, Albinana-Perez S, et al. Novel tool for deprescribing in chronic patients with multimorbidity: List of evidence-based deprescribing for chronic patients criteria. Geriatr Gerontol Int 2017;17: 2200–2207.

25. Holmes HM, Sachs GA, Shega JW, et al. Integrating palliative medicine into the care of persons with advanced dementia: Identifying appropriate medication use. J Am Geriatr Soc 2008;56: 1306–1311.

26. Mckean M, Pillans P, Scott IA. A medication review and deprescribing method for hospitalised older patients receiving multiple medications. Intern Med J 2016;46: 35–42.

27. Farrell B, Mangin D. Deprescribing is an essential part of good prescribing. Am Fam Physician 2019;99: 7–9

28. Farrell B, Black C, Thompson W, et al. Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline. Can Fam Physician 2017;63: 832–843.

29. Reeve E, Farrell B, Thompson W, et al. Evidence-Based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine. 2018 (online). Dostupné z:http://sydney.edu.au/medicine/cdpc/resources/deprescribing-guidelines.php

30. Farrel B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Can Fam Phys 2017; 63(5): 354–364.

31. Steinman MA, Landefeld CS.Overcoming Inertia to Improve Medication Use and Deprescribing.JAMA 2018;320(18): 1867–1869.

32. Martin P, Tamblyn R, Benedetti A, et al. Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial. JAMA 2018;320(18): 1889–1898.