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Randomized Controlled Trial
. 2016 Feb;66(643):e85-91.
doi: 10.3399/bjgp16X683485.

Efficacy of two interventions on the discontinuation of benzodiazepines in long-term users: 36-month follow-up of a cluster randomised trial in primary care

Caterina Vicens  1 , Ermengol Sempere  2 , Ferrán Bejarano  3 , Isabel Socias  4 , Catalina Mateu  1 , Francisca Fiol  5 , Vicente Palop  6 , Marta Mengual  7 , Silvia Folch  8 , Guillem Lera  6 , Josep Basora  9 , Alfonso Leiva  10
Affiliations
Randomized Controlled Trial

Efficacy of two interventions on the discontinuation of benzodiazepines in long-term users: 36-month follow-up of a cluster randomised trial in primary care

Caterina Vicens et al. Br J Gen Pract. 2016 Feb.

Abstract

Background: Primary care interventions that promote cessation of benzodiazepine (BZD) use in long-term users are effective at 1 year, but their efficacy at 3 years is uncertain.

Aim: To assess the 3-year efficacy of two primary care interventions delivered by GPs on cessation of BZD use in long-term users.

Design and setting: Multicentre, three-arm, cluster randomised, controlled trial, with random allocation at the GP level.

Method: Seventy-five GPs and 532 patients were randomly allocated to three groups: usual care (control), structured intervention with stepped-dose reduction and follow-up visits (SIF), or structured intervention with written stepped-dose reduction (SIW). The primary outcome was BZD use at 36 months.

Results: At 36 months, 66/168 patients (39.2%) in the SIW group, 79/191 patients (41.3%) in the SIF group, and 45/173 patients (26.0%) in the control group had discontinued BZD use. The relative risks (RR) adjusted by cluster were 1.51 (95% CI = 1.10 to 2.05; P = 0.009) in the SIW group and 1.59 (95% CI = 1.15 to 2.19; P = 0.005) in the SIF group. A total of 131/188 patients (69.7%) who successfully discontinued BZD use at 12 months remained abstinent at 36 months. The groups showed no significant differences in anxiety, depression, or sleep dissatisfaction at 36 months.

Conclusion: The interventions were effective on cessation of BZD use; most patients who discontinued at 12 months remained abstinent at 3 years. Discontinuation of BZD use did not have a significant effect on anxiety, depression, or sleep quality.

Keywords: adverse effects; benzodiazepine; general practice; primary health care; withdrawal symptoms.

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Figures

Figure 1.
Figure 1.
Flow of patients and GPs through the study. SIF = intervention group with follow-up visits. SIW = intervention group with written instructions.
See this image and copyright information in PMC

Comment in

  • Discontinuation of benzodiazepines.
    Walmsley N. Walmsley N. Br J Gen Pract. 2016 Apr;66(645):179. doi: 10.3399/bjgp16X684517. Br J Gen Pract. 2016. PMID: 27033484 Free PMC article. No abstract available.

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