Feasibility and effectiveness of deprescribing benzodiazepines and Z-drugs; systematic review and meta-analysis

Soni, Anisha; Thiyagarajan, Arun; Reeve, Joanne

Abstract

Background and Aims
2.4 million adults in England were dispensed a benzodiazepine or Z-drug (BZRA) in 2017/18, and more than 250,000 patients in the UK take BZRAs beyond the recommended duration. Deprescribing is a clinician-guided process of withdrawing inappropriate drugs. This review aims to evaluate the evidence-base supporting the feasibility and clinical effectiveness of all-forms of deprescribing initiatives used to discontinue long-term (≥4 weeks) BZRAs.
Method
Systematic review of randomised controlled trials evaluating successful BZRAs deprescribing amongst adults in community, primary or outpatient settings. MEDLINE, Embase and PsycINFO were searched from inception to February 2021. Primary outcomes were successful discontinuation in the short-term (<4 weeks) or long-term (≥4 weeks) and the occurrence of withdrawal symptoms, behavioural or psychological symptoms. Studies were categorised as pharmacological or non-pharmacological supported interventions. Study quality was assessed using the Cochrane risk of bias tool. Where appropriate, risk ratios (RRs), mean differences and 95% confidence intervals (CIs) were calculated, and Mantel-Haenszel methods using the random-effect meta-analysis was undertaken to calculate summary effect estimates.
Results
10 studies were included (n=1431 participants). Heterogeneity in study design and effect was observed. Benzodiazepines were successfully deprescribed when gradually tapered with non-pharmacological support compared to gradual tapering alone in the short-term (n=124; RR 2.02; 95%CI 1.41, 2.89), and long-term (n=123; RR 2.45; 95%CI 1.56, 3.85). Benzodiazepine deprescribing was more successful when supported by non-pharmacological methods versus routine care (n=189; RR 3.26; 95%CI 2.36, 4.51). Quality of evidence reporting effectiveness was very low to low.
Conclusions
Findings indicate it may be feasible to deprescribe benzodiazepines in the short and long-term depending on the process and support mechanisms employed. More robust trials evaluating BZRA deprescribing with clinical effectiveness outcomes are required. Realist and qualitative methods are suggested to unpick the complexities and determinants of deprescribing.

Citation

Soni, A., Thiyagarajan, A., & Reeve, J. (2022). Feasibility and effectiveness of deprescribing benzodiazepines and Z-drugs; systematic review and meta-analysis. Addiction, https://doi.org/10.1111/add.15997

• Journal Article Type: Article
• Acceptance Date: Jun 29, 2022
• Online Publication Date: Jul 11, 2022
• Publication Date: 2022
• Deposit Date: Sep 22, 2022
• Publicly Available Date: Jul 12, 2023
• Journal: Addiction
• Print ISSN: 0965-2140
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/add.15997
• Keywords: Benzodiazepines; Deprescribing; Meta-analysis; Primary care; Systematic review; Z-drugs
• Public URL: https://hull-repository.worktribe.com/output/4021183