N-of-1 trials for assessing the effects of deprescribing medications on short-term clinical outcomes in older adults: a systematic review

J Clin Epidemiol. 2018 Jan:93:112-119. doi: 10.1016/j.jclinepi.2017.09.015. Epub 2017 Sep 22.

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.

Keywords: Deprescribing; N-of-1; Older adults; Short-term outcomes; Systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clinical Trials as Topic / methods*
  • Deprescriptions*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome
  • Treatment Refusal / statistics & numerical data