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. 2025 Aug 5;194(8):2431-2439.
doi: 10.1093/aje/kwae425.

Evaluation of real-world evidence to assess health outcomes related to deprescribing medications in older adults: an International Society for Pharmacoepidemiology-endorsed systematic review of methodology

Kaleen N Hayes  1 , Joshua David Niznik  2   3   4 , Danijela Gnjidic  5 , Frank Moriarty  6 , Nha Tran  7 , Antoinette B Coe  7 , Andrew R Zullo  8 , Sirui Zhang  1 , Matthew Alcusky  9 , Dimitri Bennett  10   11 , Sirpa Hartikainen  12   13 , Marie-Laure Laroche  14   15 , Xiaojuan Li  16 , Joshua K Lin  17 , Jennifer L Lund  18 , Maurizio Sessa  19 , Shahar Shmuel  20 , Caroline Sirois  21 , Denis Talbot  22 , Miia Tiihonen  23 , Xuerong Wen  24 , Mouna J Sawan  25 , Daniela C Moga  26
Affiliations

Evaluation of real-world evidence to assess health outcomes related to deprescribing medications in older adults: an International Society for Pharmacoepidemiology-endorsed systematic review of methodology

Kaleen N Hayes et al. Am J Epidemiol. .

Abstract

Observational studies using real-world data (RWD) can address gaps in knowledge on deprescribing medications but are subject to methodological issues. Limited data exist on the methods employed to use RWD to measure the effects of deprescribing. To describe methodological approaches used in observational studies of deprescribing medications in older adults, we conducted a systematic review in Medline for observational studies published in English (January 1, 2000, to September 14, 2023) that examined the health effects of medication deprescribing in older adults. We described study characteristics and methods, focusing on the operationalization of deprescribing as an exposure and potential time-related biases. Forty-five studies were included, representing a variety of drug classes (eg, statins, aspirin, bisphosphonates) and diseases. Most studies adequately addressed potential time-related biases. The definition of deprescribing was not clearly defined in 12 studies. There was heterogeneity regarding the minimum duration of time that qualified as deprescribing, even within a drug class; fewer than one-third of studies provided a justification for these definitions. Observational studies are common to examine the effects of deprescribing; however, there were inconsistencies in measuring deprescribing and a lack of transparency in reporting. There is a need for minimum sufficient reporting criteria for observational studies on deprescribing.

Keywords: Pharmacoepidemiology; deprescribing; epidemiologic methods; geriatrics; inappropriate prescribing; polypharmacy; research methodology; systematic review.

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Conflict of interest statement

K.N.H. has received investigator-initiated grant funding paid directly to Brown University for investigator-initiated research from Sanofi, Genentech, and GlaxoSmithKline for research on influenza vaccination in nursing homes, influenza outbreak control, and shingles vaccination in nursing homes, respectively. K.N.H. has also served as a consultant for Canada’s Drug Agency (formerly the Canadian Agency for Drugs and Technologies in Health) for the development of reporting guidance for real-world evidence. D.B. is an employee of Takeda. S.S. is a full-time employee of Pfizer with stock. A.R.Z. has received grant funding paid directly to Brown University for collaborative research on the epidemiology of infections, vaccinations, and respiratory syncytial virus. A.B.C. is supported by the National Institute on Aging (K08 AG071856). J.L.L.’s spouse was formerly employed by and previously owned stock in GSK. D.C.M., D.G., D.T., S.H., M.-L.L., M.T., and J.D.N. report no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram describing systematic literature search for pharmacoepidemiologic studies examining the effects of deprescribing on health outcomes in older adults.
Figure 2
Figure 2
Proportion of studies addressing potentially relevant confounders.
See this image and copyright information in PMC

References

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