Is "More" Always Better than "Less"? Deprescribing to Improve Patients' Clinical Outcomes: A Case Series

Polypharmacy represents a significant clinical concern, particularly among elderly patients, due to the increased risk of adverse drug reactions (ADRs). This population is often affected by multiple comorbidities and is typically followed by various specialists, which can lead to the concurrent use of multiple medications, commonly defined as polypharmacy when five or more drugs are prescribed. The use of numerous medications heightens the potential for drug-drug interactions (DDIs), thereby increasing the likelihood of ADRs. Deprescribing has emerged as a potential strategy to mitigate pharmacological risk. While the theoretical benefits of deprescribing are well recognized, real-world clinical data are essential to substantiate its efficacy and safety. Discontinuing certain medications may prove beneficial in some cases, yet potentially harmful in others. This study aimed to present a case series that highlights the positive clinical impact of deprescribing in elderly patients undergoing polypharmacy.

The first case involves an 86-year-old male with Alzheimer's disease, presenting with delusions, cognitive decline, and behavioral disturbances. The second case concerns an 88-year-old bedridden female with vascular dementia, characterized by hallucinations and delusions. The third case concerns an 82-year-old female with major depressive disorder, Parkinsonism, and vascular cerebropathy, who was experiencing drowsiness and confusion. In all three cases, deprescribing led to a marked improvement or complete resolution of clinical symptoms. Patients were selected based on the onset of ADRs and the presence of concerning clinical symptoms. Medication regimens were thoroughly reviewed by a multidisciplinary team comprising clinical pharmacologists and geriatricians, utilizing tools, such as Intercheck and DrugPin, to identify potential drug interactions. Clinical improvement and symptom resolution were used as outcome measures to evaluate the effectiveness of deprescribing.

This case series illustrates how careful and evidence-informed deprescribing in elderly patients with polypharmacy can significantly reduce the incidence of ADRs, thereby improving clinical outcomes and enhancing therapeutic adherence. These findings underscore the importance of integrating deprescribing into routine geriatric care as a personalized and patientcentered approach.