BACKGROUND: Polypharmacy is becoming more prevalent and evaluation ofappropriateness of medication use is increasingly important. The primary carephysician often conducts the deprescribing process;... Show moreBACKGROUND: Polypharmacy is becoming more prevalent and evaluation ofappropriateness of medication use is increasingly important. The primary carephysician often conducts the deprescribing process; however, there are severalbarriers to implementing this.AIM: To examine the feasibility and safety of discontinuation of medication, witha focus on studies that have been conducted in the community, that is, primarycare (or general practice) and nursing homes.DESIGN AND SETTING: This systematic review included randomised controlled trials published in 2005-2017, which studied withdrawal of long-term drugs prescribed inprimary care settings and compared continuing medication with discontinuing.METHOD: PubMed and EMBASE searches were conducted and the extracted data includedthe number of patients who successfully stopped medication and the number ofpatients who experienced relapse of symptoms or restarted medication.RESULTS: A total of 27 studies reported in 26 papers were included in thisreview. 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%, andthe range of reported relapse varied from 1.9% to 80%.CONCLUSION: Only a few studies have examined the success rate and safety ofdiscontinuing medication in primary care, and these studies are veryheterogeneous. Most studies show that deprescribing and cessation of long-termuse seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions aboutdeprescribing in primary care settings. Show less
Chatzidionysiou, K.; Emamikia, S.; Nam, J.; Ramiro, S.; Smolen, J.; Heijde, D. van der; ... ; Landewe, R. 2017
Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper... Show moreTreatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion. Show less
