Methodology for Developing Deprescribing Guidelines: Using Evidence and GRADE to Guide Recommendations for...

Area of Science:

• Clinical Pharmacology
• Evidence-Based Medicine
• Health Services Research

Background:

• Class-specific deprescribing guidelines are needed to help clinicians safely stop medications that are no longer beneficial or cause harm.
• Existing methods for guideline development, evidence synthesis, and recommendation rating were adapted for deprescribing.

Purpose of the Study:

• To develop and refine a methodology for creating evidence-based deprescribing guidelines.
• To demonstrate the application of this methodology through the development of three specific guidelines.

Main Methods:

• A national modified Delphi consensus process identified deprescribing guideline priorities.
• Systematic searches and reviews synthesized evidence on deprescribing trial outcomes, effectiveness, and harm.
• An 8-step guideline development process was followed, incorporating clinical and stakeholder review.

Main Results:

• A novel methodology for deprescribing guideline development was established and tested.
• Three deprescribing guidelines (for proton pump inhibitors, benzodiazepine receptor agonists, and antipsychotics) were created.
• Innovative aspects included synthesizing tapering/stopping outcomes and incorporating medication harm into recommendations.

Conclusions:

• The developed methodology is effective for creating deprescribing guidelines.
• Future guidelines can benefit from considering short/long-term outcomes and patient preferences.
• This work supports the development of future deprescribing guidelines and decision-support tools.