Evidence map›Paper›PMID 28456823›Full record

SynthesisEuropean journal of clinical pharmacology2017

A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people.

Emily Reeve, Magdalene Ong, Angela Wu, Jesse Jansen, Mirko Petrovic, Danijela Gnjidic

Registry-linked trialAbstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European journal of clinical pharmacology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03689049 (SPIDER), which is not on this map. Cited by 90 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 8 pooled it
13.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03689049 naactive not recruitingnot on this mapstarted 2018, after this paper: background citation

SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients

TypeinterventionalSponsorUniversity of Toronto Practice Based Research NetworkRan2018 to 2027Enrolled104ConditionsPolypharmacy, Inappropriate Prescribing, Aged, Primary Health CareArmsSPIDER, Usual Care
3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 8 syntheses or guidelines pooled it, 197 citations in OpenAlex.

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30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Emily ReeveCognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, Australia. emily.reeve@sydney.edu.au.ORCID http://orcid.org/0000-0002-1405-999X
Magdalene OngFaculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia.
Angela WuFaculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia.
Jesse JansenWiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Mirko PetrovicDepartment of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Danijela GnjidicFaculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia.
The University of Sydney · AUGhent University · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeBenzodiazepines are effective medicines for insomnia and anxiety but are commonly used beyond recommended treatment time frames, which may lead to adverse drug events. The aim of this systematic review was to critically evaluate the success of interventions used to reduce benzodiazepines and 'Z-drug' use, and the impact of these interventions on clinical outcomes in older adults.

methodsA search was conducted in PubMed, Embase, Informit, International Pharmaceutical Abstracts, Scopus, PsychINFO, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL. Studies conducted in older adults (≥65 years) and published between January 1995 and July 2015 were included. Two authors independently reviewed all articles for eligibility and extracted the data.

resultsSeven studies of benzodiazepines and Z-drug withdrawal were identified. Benzodiazepine discontinuation rates were 64.3% in one study that employed pharmacological substitution with melatonin and 65.0% in a study that employed general practitioner-targeted intervention. Mixed interventions including patient education and tapering (n = 2), pharmacological substitution with psychological support (n = 1) and tapering with psychological support (n = 1) yielded discontinuation rates between 27.0 and 80.0%. Five studies measured clinical outcomes following benzodiazepine discontinuation. Most (n = 4) observed no difference in prevalence of withdrawal symptoms or sleep quality, while one study reported decline in quality of life in those who continued taking benzodiazepine vs. those who discontinued over 8 months.

conclusionsCurrent evidence shows that benzodiazepine withdrawal is feasible in the older population, but withdrawal rates vary according to the type of intervention. As the benefits and sustainability of these interventions are unclear, further studies should be conducted to assess this.

Indexed as

DeprescriptionsAgedBenzodiazepinesHumansHypnotics and SedativesSleep Initiation and Maintenance DisordersBenzodiazepinesHypnotics and SedativesBenzodiazepinesDeprescribingOlder adultsZ-drugs

Identifiers

PMID28456823
OpenAlexW2610021354

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.