For studies to do with general polypharmacy, or which did not focus on a specific drug class.
The evidence table summarising the evidence supporting the recommendations for deprescribing of polypharmacy is presented in this table.
| Article | Tool to identify target drugs | Study design | Sample size | Follow-up (months) | Withdrawal schedule |
| Allard 2001 | Potentially inappropriate medicines | Cluster RCT | 266 | 12 | Not described |
| Baqir 2017 | Northumbria 3Q Approach | Before-and-after study | 422 | 1 | Not described |
| Beer 2011 | Polypharmacy- pre-specified list of medicines | RCT | 44 | 3 | Dose reduced at approximately two-weekly intervals |
| Blenke 2017 | STOPP/START criteria | Before-and-after study | 45 | 3 | One drug at a time |
| Boye 2017 | Falls risk increasing drugs | RCT | 612 | 12 | Not described |
| Campins 2017 | Good Palliation- Good Practice tool, andSTOPP/START criteria | RCT | 503 | 12 | Individualised/drug specific |
| Clyne 2015 | Potentially inappropriate medicines | Cluster RCT | 196 | 6 | Individualised/drug specific |
| Cossette 2017 | Beers’ and STOPP/START criteria | RCT | 231 | 1 | Not described |
| Dalleur 2014 | STOPP/START criteria | RCT | 158 | 12 | Not described |
| Edey 2019 | Study-specific deprescribing guide | Non-randomised clinical trial | 358 | 1 | Not described |
| Fog 2017 | STOPP/START criteria, DRUID drug interactions list, Norwegian General Practice criteria (NORGEP) | Before-and-after study | 2465 | Nil | Not described |
| Gallagher 2011 | STOPP/START criteria | RCT | 400 | 6 | Not described |
| Garcia-Gollarte 2014 | STOPP/START criteria | RCT | 1018 | 6 | Not described |
| Garfinkel 2007 | Good Palliation-Good Practice tool | Prospective cohort study | 190 | 12 | Not described |
| Garfinkel 2010 | Good Palliation-Good Practice tool | Before-and-after study | 70 | Mean 19.2 ± 11.4 | Not described |
| Garfinkel 2019 | Good Palliation- Good Practice | Single arm intervention study | 193 | 36 | Individualised/drug specific |
| Gerety 1993 | Polypharmacy | Before-and-after study | 132 | 6 | Not described |
| Gnjidic 2010 | Drug Burden Index | Cluster RCT | 115 | 3 | Not described |
| Hanlon 1996 | >3 months use, Medicines Appropriateness Index used | RCT | 208 | 12 | Not described |
| Ilic 2015 | Beers’ and STOPP/START criteria | Before-and-after study | 104 | 6 | Not described |
| Komagamine 2017 | Study-specific criteria | Retrospective cohort study | 164 | 8 | Not described |
| Kroenke 1990 | Polypharmacy | Prospective cohort study | 79 | 6 | Not described |
| Marvin 2016 | Falls risk increasing drugs, study-specific list | Prospective cohort study | 100 | Until hospital discharge | Not described |
| McKean 2015 | Study-specific deprescribing tool | Prospective pilot study | 50 | Until hospital discharge | Not described |
| Muir 2001 | Polypharmacy | Non-randomised controlled trial | 836 | 1.7 (7 weeks) | Not described |
| Mudge 2015 | Pharmacist/ physician consensus | Single arm intervention pilot study | 17 | 3 | Not described |
| Petersen 2018 | Study-specific list | Non-randomised pilot study | 40 | Until hospital discharge | Dose reduction or discontinuation |
| Pfister 2017 | Drug related problems | Before-and-after study | 212 | Until hospital discharge | Not described |
| Piau 2017 | Potentially inappropriate medicines | Retrospective cohort study | 216 | Until hospital discharge | Not described |
| Pitkala 2001 | Polypharmacy | Pseudo-randomised controlled trial | 174 | 2 | Not described |
| Pitkala 2014 | Beers’ criteria | Cluster RCT | 227 | 12 | Not described |
| Potter 2016 | Modified Good Palliation-Good Practice tool | RCT | 95 | 12 | Dose reduced at approximately two-weekly intervals |
| Poudel 2015 | Study-specific list based on the literature | Prospective cohort study | 153 | 18 | Not described |
| Ros 2017 | Medication Appropriateness Index | Before-and-after study | 49 | 3 | Individualised |
| Sakakibara 2015 | Polypharmacy | Non-randomised controlled trial | 50 | 6 | Not described |
| Salonoja 2012 | Falls risk increasing medicines, psychotropic medicines, benzodiazepines | Non-randomised RCT, 2 x 2 factorial | 591 | 48 | Geriatrician provided plans to users to gradually reduce these medicines as a step-wise procedure over some months |
| Schafer 2017 | Polypharmacy | Cluster RCT | 650 | 12 | Not described |
| Stuckey 2018 | Beer’s criteria | Before-and-after study | 34 | 3 | Individualised |
| Swift 2018 | Polypharmacy and drug related problems | Before-and-after study | 749 | Nil | Individualised |
| Tomita 2018 | Polypharmacy | Prospective cohort study | 494 | Until hospital discharge | Not described |
| Unutmatz 2018 | Potentially inappropriate medicines | Before-and-after study | 1579 | Nil | Not described |
| Van der Linden 2017 | Polypharmacy | Non-randomised controlled trial | 172 | 3 | Not described |
| Van der Linden 2018 | Potentially inappropriate medicines | Before-and-after study | 59 | Until hospital discharge | Not described |
| van der Velde 2007 | Falls risk increasing medicines | Case-control study | 141 | 2 | Abrupt discontinuation, if safe, else reduced dose over 1-month to a lower dose or to complete withdrawal |
| van Summeren 2017 | Polypharmacy using outcome prioritisation tool | Single arm intervention pilot study | 59 | 2-8 | Not described |
| Vandenburg 2018 | Beers criteria | Quality improvement program | 7000 | 14 | Not described |
| Verdoorn 2018 | Drug-related problems | Before-and-after study | 7403 | 8 | Not described |
| Verdoorn 2019 | Polypharmacy using goal attainment scaling | Before-and-after study | 315 | 6 | Not described |
| Weber 2008 | Polypharmacy, psychoactives, inappropriate doses | Cluster-RCT | 620 | 15 | Not described |
| Whitman 2018 | Beers, STOPP/ START criteria, Medication Appropriateness Index | Before-and-after study | 26 | Mean 14 days | Individualised |
| Wouters 2017 | Multidisciplinary Multistep Medication (3MR) review | Cluster RCT | 426 | 4 | Not described |
Outcome: Deprescribing
| Study | Specific outcome | Odds ratio (95% CI) | Mean difference (95% CI) |
| Allard 2001 | Total medicines prescribed | 0.11 (-0.37 to 0.59) | |
| Kroenke 1990 | Total medicines prescribed | -0.31 (-0.76 to 0.13) | |
| Muir 2001 | Total medicines prescribed | -2.55 (-2.64 to -2.46) | |
| Pitkala 2014 | Total medicines prescribed | -0.13 (-0.67 to 0.41) | |
| Potter 2016 | Total medicines prescribed | -1.93 (-3.75 to -0.11) | |
| Baqir 2017 | Total medicines stopped | Mean 2.36 (SD 1.53) stopped | |
| Campins 2017 | Total medicines stopped | Mean 1.41 (SD 1.18) stopped | |
| Allard 2001 | Change in potentially inappropriate medicines | 0.09 (-0.06 to 0.24) | |
| Pitkala 2014 | Change in potentially inappropriate medicines | -0.54 (-0.88 to -0.20) | |
| Allard 2001 | At least one change in inappropriate meds | 2.33 (0.97 to 5.55) | |
| Gallagher 2011 | At least one change in inappropriate meds | 0.13 (0.07 to 0.23) | |
| Campins 2017 | Drug discontinuation | 1.85 (1.17 to 2.90) | |
| Campins 2017 | Dose adjustments | 3.94 (2.70 to 5.74) | |
| Hanlon 1996 | Medicines Appropriateness Index (lower better) | -3.90 (-4.09 to -3.71) | |
| Gallagher 2011 | Medicines Appropriateness Index, improved scores | 4.47 (2.90 to 6.89) | |
| Gnjidic 2010 | Drug Burden Index improved | 0.37 (0.31 to 3.37) | |
| Yeh 2013 | Clinician-rated anticholinergic score | -0.6 (-1.07 to -0.12) | |
Outcome: Mortality
| Study | Specific outcome | Odds ratio (95% CI) | Mean difference (95% CI) |
| Allard 2000 | 0.38 (0.14 to 1.03) | ||
| Beer 2011 | 3.77 (0.15 to 97.75) | ||
| Campins 2017 | Death at 12 months | 1.16 (0.38 to 3.52) | |
| Dalleur 2014 | 1.06 (0.37 to 2.97) | ||
| Gallagher 2011 | 0.70 (0.31 to 1.63) | ||
| Garcia-Gollarte 2014 | 1.24 (0.82 to 1.87) | ||
| Garfinkel 2007 | 0.32 (0.17 to 0.62) | ||
| Gnjidic 2010 | 0.14 (0.01 to 2.73) | ||
| Hanlon 1996 | 0.66 (0.24 to 1.82) | ||
| Pitkala 2014 | 1.16 (0.65 to 2.07) | ||
| Potter 2016 | 0.57 (0.24 to 1.38) | ||
| Weber 2008 | 0.60 (0.28 to 1.22) | ||
| Yeh 2013 | 0.22 (0.01 to 5.56) |
Outcome: Exacerbation of underlying condition
| Study | Specific outcome | n | Mean difference (95% CI) |
| Baqir 2017 | Medicines restarted | 7/422 residents | |
Outcome: Withdrawal effects
| Study | Specific outcome | Odds ratio (95% CI) | Mean difference (95% CI) |
| Hanlon 1996 | ?? | 118.06 (7.13 to 1954.32) | |
Outcome: Adverse drug effects
| Study | Specific outcome | Odds ratio (95% CI) | Mean difference (95% CI) |
| Hanlon 1998 | ?? | 0.66 (0.35 to 1.24) | |
Outcome: Clinical events
| Study | Specific outcome | Odds ratio (95% CI) | Mean difference (95% CI) |
| Boye 2016 | At least one fall | 1.21 (0.87 to 1.70) | |
| Campbell 1999 | At least one fall | 0.07 (0.01 to 0.35) | |
| Gallagher 2011 | At least one fall | 0.68 (0.30 to 1.50) | |
| Garcia-Gollarte 2014 | At least one fall | 0.80 (0.58 to 1.13) | |
| Potter 2016 | At least one fall | 0.62 (0.27 to 1.42) | |
| Salonoja 2012 | At least one fall | 0.84 (0.51 to 1.40) | |
| Van der Velde 2007 | At least one fall | 0.64 (0.30 to 1.37) | |
| Weber 2008 | At least one fall | 1.06 (0.66 to 1.71) | |
| Boye 2016 | Time to first fall | HR 1.17 (0.89 to 1.54) | |
| Boye 2016 | Time to second fall | HR 1.19 (0.78 to 1.82) | |
| Boye 2016 | Time to fall-related GP visit | HR 0.66 (0.42 to 1.06) | |
| Boye 2016 | Time to fall-related ED visit | HR 0.85 (0.43 to 1.68) | |
| Campins 2017 | Hospitalization | 0.87 (0.57 to 1.31) |
Outcome: Other
| Study | Specific outcome | Odds ratio (95% CI) | Mean difference (95% CI) |
| Beer 2011 | Pittsburgh Sleep Quality Index | 1.03 (-1.02 to 3.02) | |
| Beer 2011 | Mini Mental Status Exam | 0 (-1.34 to 1.34) | |
| Yeh 2013 | Mini Mental Status Exam | -0.4 (-1.51 to 0.71) | |
| Beer 2011 | Quality of life: SF-36 | -5.0 (-18.58 to 8.58) | |
| Hanlon 1996 | Quality of life: SF-36 | 2.20 (1.70 to 2.70) | |
| Beer 2011 | Quality of life: EQ-5D | 9.00 (-8.02 to 26.02) | |
| Pitkala 2014 | Quality of life: 15D | 0.03 (0.01 to 0.06) | |
| Van der Velde 2007 | Functional reach test | 3.5 (0.48 to 6.52) | |
| Van der Velde 2007 | 10 min walk | -4.7 (-7.17 to -2.22) | |
| Yeh 2013 | Barthel Index (dependence) | 3.8 (-2.58 to 10.19) | |