Deprescribing recommendations: An essential consideration for clinical guideline developers

Area of Science:

• Gerontology
• Pharmacology
• Evidence-Based Medicine

Background:

• Clinical guidelines frequently overlook deprescribing, particularly for frail patients with multiple conditions.
• Complex medication regimens in these patients increase the risk of adverse drug events.
• Deprescribing, a key aspect of rational prescribing, is often neglected in guidelines.

Purpose of the Study:

• To advocate for the routine inclusion of deprescribing recommendations in clinical guidelines.
• To identify challenges hindering deprescribing guideline integration.
• To explore the potential of the GRADE system in addressing these challenges.

Main Methods:

• Discussion and recommendations from the Bruyère Evidence-Based Deprescribing Guidelines Symposium (March 2018).
• Analysis of current limitations in clinical guidelines regarding deprescribing.
• Evaluation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system's applicability.

Main Results:

• Limited evidence, lack of awareness, conflicts of interest, and insufficient research incentives impede deprescribing guideline inclusion.
• Current systems and stakeholders have not prioritized deprescribing recommendations.
• The GRADE system offers potential solutions through its structured approach to evidence, values, and conflicts of interest.

Conclusions:

• Integrating deprescribing into clinical guidelines is crucial for improving evidence-based practice and patient outcomes.
• Adapting GRADE methodology for deprescribing requires further development.
• Systematic inclusion of deprescribing recommendations represents a significant opportunity to enhance patient care.