In the realm of healthcare, the art of deprescribing is gaining momentum, and it's about time. The concept, which involves systematically discontinuing medications when their potential harms outweigh their benefits, is a complex and multifaceted topic. As the International Society for Pharmacoepidemiology (ISPE) conference in Milan highlighted, the issue is particularly pertinent in Italy, where a staggering 28% of individuals over 65 take more than 10 medications, with some even managing 20 or more.
One of the key challenges in deprescribing is defining it. Shanna Trenaman, PhD, from Dalhousie University, explains that deprescribing is not just about discontinuing a drug; it's a person-centered approach to ensure the best possible outcomes. It's about understanding the patient's values, preferences, and current level of functioning, and then making informed decisions about medication. This is a delicate balance, as it requires assessing the impact of deprescribing, which presents a host of methodological questions.
The ISPE has taken a proactive approach, publishing two documents in 2025 to guide the way forward. Daniela Moga, MD, PhD, presented these documents, which offer a comprehensive guide with 23 recommendations for reporting and methodological considerations in observational studies. The first document, a systematic review, identified gaps in methodology, such as the lack of consideration for gradual dose reduction and the need for clearer definitions of 'time zero'.
The second document, REMROSE-D, aims to address these issues. However, as Sri Harsha Chalasani from JSS College of Pharmacy points out, the success of deprescribing also depends on taking the patient's perspective into account. Empathy-based deprescribing is crucial, but there's a lack of ad hoc tools to assess these factors.
The benefits of deprescribing are clear. Reduced risk of drug interactions, fewer adverse events, and improved quality of life for patients are just the tip of the iceberg. For healthcare providers, it's about managing polypharmacy in frail patients, and for health systems, it's about reducing costs and improving efficiency. However, the challenges are equally daunting.
Patients must trust their doctors, understand the rationale behind deprescribing, and overcome cultural and social barriers. Healthcare professionals must build trust, resist defensive medicine, and manage time constraints. Health systems, meanwhile, must invest in training, provide regular feedback, and align reimbursement systems with deprescribing goals.
According to Gianluca Trifirò, MD, there are three key areas for improvement: training, organizational models, and research. In Italy, university courses and a program sponsored by 12 scientific societies are helping to build capacity. The results achieved through dedicated services in Verona are particularly promising.
The future of deprescribing looks bright, but it won't happen overnight. Collaboration among professionals, sustained effort to build trust with patients, and the development of supportive tools are essential. Technology can play a crucial role, with tools that help determine when a medication might be discontinued and support physicians in their treatment decisions.
In my opinion, the ISPE's focus on deprescribing is a welcome development. It's a complex issue, but with the right approach, we can make significant strides in improving patient care and outcomes. The challenges are real, but so are the potential benefits. It's time to embrace the art of deprescribing and make it a routine part of daily medical practice.
