Deprescribing is the act of withdrawing a treatment prescription from patients for whom a medication has become inappropriate or in whom the risks may now outweigh the benefits. However, trials examining the effects of deprescribing are often complex and multi-faceted, and reporting of these trials can miss important aspects such as patient selection and length of follow-up.
A recently published paper by Blom et al. used a multistep process to develop a reporting guideline for deprescribing trials based on a systematic review of this body of research, paying close attention to those aspects that most commonly went unreported. The result was an elaboration of the Consolidated Standards of Reporting Trials (CONSORT) statement, with the addition of items reviewed by a panel of 14 experts in the areas of ranging from pharmacology and geriatric medicine to statistics and reporting guidelines. The process, which ended with a one-day face-to-face meeting to approve the elaborated items, also took into account the Template for Intervention Description and Replication (TIDieR) checklist to ensure that a comprehensive list was created.
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The panel determined that all items of the original CONSORT checklist are applicable to deprescribing trials, but that certain items required further detail. The CONSORT items that required the most attention with regards to deprescribing studies included the following:
- description of trial design
- participant selection
- detailed information that would allow replication of the intervention studied
- pre-specification of primary and secondary outcome
- discussion of adverse events and harms, including those related to drug withdrawal
- defined periods of recruitment and follow-up
In addition to improving the quality of reporting in deprescribing trials, the authors also recommend increasing the amount of dedicated funds available for deprescribing studies, which are currently scarce and not incentivized by common streams of research funding.
Blom, J.W., Muth, C., Glasziou, P., McCormarck, J.P., Perera, R., Poortvliet, R.K.E..., & Knottnerus, J.A. 2020. Describing deprescribing trials better: An elaboration of the CONSORT statement. J Clin Epidemiol 127: 87-95.
Manuscript available from the publisher's website here.