Alexander J Clough1, Sarah N Hilmer2, Sharon L Naismith3, Luke D Kardell4, Danijela Gnjidic4. 1. Faculty of Pharmacy, Pharmacy and Bank Building, University of Sydney, Science Road, Camperdown, Sydney, New South Wales, Australia, 2050; Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research and University of Sydney, St Leonards, New South Wales, Australia, 2065. Electronic address: aclo4212@uni.sydney.edu.au. 2. Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research and University of Sydney, St Leonards, New South Wales, Australia, 2065; Department of Clinical Pharmacology and Aged Care, Sydney Medical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia, 2065. 3. Charles Perkins Centre, School of Pyschology and the Brain & Mind Centre, University of Sydney, Camperdown, New South Wales, Australia, 2050. 4. Faculty of Pharmacy, Pharmacy and Bank Building, University of Sydney, Science Road, Camperdown, Sydney, New South Wales, Australia, 2050; Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research and University of Sydney, St Leonards, New South Wales, Australia, 2065.
Abstract
OBJECTIVES: The objective of this study was to determine the applicability of utilizing the N-of-1 method for deprescribing trials in older adults. STUDY DESIGN AND SETTING: Systematic review of any human studies conducted in older adults (≥50 years), deprescribing any long-term treatment over less than a year using the N-of-1 trial method was performed. Two authors independently reviewed all articles for eligibility and extracted data. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality assessment of trials was carried out using the Physiotherapy Evidence Database scale. RESULTS: Six studies were identified and extracted. Trials investigated the efficacy of pharmacological and non-pharmacological therapies for treating diseases. Four trials demonstrated non-significant benefits of treatment, with a significant number of patients discontinuing their medications in two trials where follow-up data was collected (N = 8/18, 9/14 [44.4--64.3%]). In two studies, where treatment was beneficial, all participants were found to be maintaining regimen at follow-up. CONCLUSION: The N-of-1 trial methodology can be used to generate patient-specific evidence of medication and inform prescribing decisions. Future studies are required to assess the feasibility of using the N-of-1 method to determine the effects of deprescribing medications on short-term outcomes.
OBJECTIVES: The objective of this study was to determine the applicability of utilizing the N-of-1 method for deprescribing trials in older adults. STUDY DESIGN AND SETTING: Systematic review of any human studies conducted in older adults (≥50 years), deprescribing any long-term treatment over less than a year using the N-of-1 trial method was performed. Two authors independently reviewed all articles for eligibility and extracted data. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality assessment of trials was carried out using the Physiotherapy Evidence Database scale. RESULTS: Six studies were identified and extracted. Trials investigated the efficacy of pharmacological and non-pharmacological therapies for treating diseases. Four trials demonstrated non-significant benefits of treatment, with a significant number of patients discontinuing their medications in two trials where follow-up data was collected (N = 8/18, 9/14 [44.4--64.3%]). In two studies, where treatment was beneficial, all participants were found to be maintaining regimen at follow-up. CONCLUSION: The N-of-1 trial methodology can be used to generate patient-specific evidence of medication and inform prescribing decisions. Future studies are required to assess the feasibility of using the N-of-1 method to determine the effects of deprescribing medications on short-term outcomes.
Authors: Parag Goyal; Tatiana Requijo; Birgit Siceloff; Megan J Shen; Ruth Masterson Creber; Sarah N Hilmer; Ian M Kronish; Mark S Lachs; Monika M Safford Journal: Drugs Aging Date: 2020-02 Impact factor: 3.923
Authors: Parag Goyal; Monika M Safford; Sarah N Hilmer; Michael A Steinman; Daniel D Matlock; Mathew S Maurer; Mark S Lachs; Ian M Kronish Journal: Br J Clin Pharmacol Date: 2022-07-13 Impact factor: 3.716
Authors: Alexander J Clough; Sarah N Hilmer; Lisa Kouladjian-O'Donnell; Sharon L Naismith; Danijela Gnjidic Journal: Pharmacol Res Perspect Date: 2019-04-25