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

Polypharmacy is increasingly common among older adults with chronic diseases, yet clinical practice guidelines mainly emphasise initiating therapies rather than discontinuing them. This imbalance contributes to overprescription, therapeutic inertia and preventable harm.

To assess the prevalence and quality of recommendations for treatment discontinuation in European guidelines for chronic diseases published between 2019 and 2024.

A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards using the Trip Medical Database. All European clinical practice guidelines on chronic disease management for adults were included, excluding those related to oncology, acute care, paediatrics, obstetrics and palliative care. Data were extracted on the presence, rationale and strength of recommendations for discontinuing or avoiding treatments.

Of 3551 records retrieved, 724 guidelines met inclusion criteria. Only 49 contained any mention of treatment discontinuation, most often linked to toxicity or lack of efficacy. A single guideline-from the European AIDS Clinical Society-provided explicit deprescribing algorithms and criteria. Personalised, patient-centred approaches to deprescribing and structured decision frameworks were rarely described.

Deprescribing remains underrepresented in European clinical guidelines. There is an urgent need to shift from a disease-centred model to patient-centred care, with guidelines that provide clear, evidence-based strategies to discontinue medications that no longer offer clinical benefit. Scientific societies should lead to the development of recommendations that promote safe, rational and personalised prescribing, ensuring real benefits for patients while minimising risks. The entire process must be individualised and necessarily involve shared decision-making with patients, families and caregivers.