Methodological Review of Real-World Data Studies on Deprescribing in Older Adults

Overview

This systematic review analyzed 45 observational studies using real-world data to evaluate health outcomes of medication deprescribing in older adults. It found considerable heterogeneity and lack of clarity in defining deprescribing, with many studies not justifying their operational definitions, despite most addressing time-related biases adequately.

Background

Deprescribing involves the supervised tapering or stopping of medications to reduce polypharmacy risks and improve patient outcomes, especially in older adults. Randomized controlled trials face challenges in this population, making observational studies using real-world data (RWD) valuable. However, RWD studies face methodological challenges including defining deprescribing exposure, confounding, and time-related biases. There is a lack of standardized methods and reporting guidelines for deprescribing research using RWD.

Data Highlights

Forty-five observational studies published between 2000 and 2023 were included, covering various drug classes such as statins, aspirin, and bisphosphonates. Twelve studies did not clearly define deprescribing, and fewer than one-third justified their minimum duration criteria for deprescribing. Most studies adequately addressed potential time-related biases.

Key Findings

• Deprescribing definitions varied widely across studies, even within the same drug class.
• Less than one-third of studies provided justification for their deprescribing duration thresholds.
• Most studies addressed time-related biases such as immortal time bias appropriately.
• There was a lack of transparency and consistency in reporting deprescribing exposure and methods.
• Observational studies using RWD are common but face challenges including confounding by indication and misclassification of deprescribing.
• There is a need for minimum sufficient reporting criteria to improve study quality and comparability.

Clinical Implications

Clinicians and researchers should be aware of the variability and methodological limitations in current deprescribing observational studies using RWD. Standardized definitions and transparent reporting are essential to accurately interpret deprescribing effects and to guide clinical decision-making. Improved methodological rigor will enhance the reliability of evidence supporting deprescribing practices in older adults.

Conclusion

Observational studies using real-world data are valuable for studying deprescribing effects in older adults but currently suffer from inconsistent definitions and reporting. Establishing standardized methodological guidelines is critical to advance deprescribing research and its clinical application.

References

1. International Society for Pharmacoepidemiology Supported Systematic Review 2023 -- Analysis of Real-World Data Methodologies for Evaluating Health Outcomes of Medication Deprescribing in Older Adults