Support for deprescribing in European clinical practice guidelines: a systematic review

Area of Science:

• Geriatric Medicine
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• Polypharmacy is prevalent in older adults with chronic conditions.
• Clinical guidelines often focus on starting, not stopping, medications.
• This leads to overprescription, therapeutic inertia, and patient harm.

Purpose of the Study:

• To evaluate the frequency and quality of recommendations for discontinuing treatments in European chronic disease guidelines.
• Focus on guidelines published between 2019 and 2024.

Main Methods:

• Systematic review adhering to PRISMA 2020 standards.
• Searched Trip Medical Database for European adult chronic disease guidelines (excluding oncology, acute care, pediatrics, obstetrics, palliative care).
• Extracted data on presence, rationale, and strength of discontinuation recommendations.

Main Results:

• 724 guidelines met inclusion criteria; only 49 mentioned treatment discontinuation.
• Discontinuation mentions were typically linked to toxicity or lack of efficacy.
• Few guidelines offered explicit deprescribing algorithms or patient-centered frameworks.

Conclusions:

• Deprescribing is underrepresented in current European clinical guidelines.
• A shift towards patient-centered care with clear deprescribing strategies is urgently needed.
• Scientific societies must develop evidence-based, personalized recommendations for safe medication discontinuation.