The STOPPFrail criteria decreases medication use and costs without short-term harms

Référence

Curtin D, Jennings E, Daunt R, et al. Deprescribing in older people approaching end of life: a randomized controlled trial using STOPPFrail criteria. J Am Geriatr Soc 2020;68(4):762-769.

Sommaire

The STOPPFrail criteria, developed to refine other deprescribing tools, consist of 27 indicators of potentially inappropriate prescribing in older persons who are "approaching end of life." The core elements include significant frailty with limited life expectancy, severe cognitive impairment, decision to focus on symptom control, the harm of medication outweighs the benefit, challenging medication administration or monitoring, and adherence is difficult. Additionally, the criteria encourage deprescribing poorly tolerated medications and those without a clear indication. Finally, the criteria include guidance for multiple drug classes. These researchers enrolled patients aged at least 75 years who were hospitalized in 1 of 2 Irish hospitals. The patients had to be frail (using a standardized tool) and unable to return home, had to be taking at least 5 medications, and their treating physician had to report that he or she would not be surprised if the patient died within the next 12 months. The authors randomized these eligible patients to usual care (n = 65) or to STOPPFrail-guided deprescribing (n = 65). Twelve intervention patients died (4 before hospital discharge) compared with 18 control patients (6 before hospital discharge), attesting to the frailty of the patients. In the intervention group, there was at least one deprescribing recommendation for 91% of the patients, with an average of 2.4 deprescribing recommendations per patient. Overall, 88% of the recommendations were accepted by the treating physician. Three months after discharge, the surviving intervention patients took 2.6 fewer medications compared with 0.36 fewer medications in the control group. Overall, this meant that the intervention patients took between 1 and 3 fewer medications than the control patients, which translated into a net savings of approximately $62 per month. The authors did not find any significant differences in interval emergency department visits, unplanned admissions, deaths, unscheduled primary care visits, falls, or nonvertebral fractures. However, the frequency of these outcomes was quite low, and a larger study is needed to determine if any of them might be significant.