A meta-analysis of 49 randomized controlled trials involving 39,336 patients found low-certainty evidence that pharmacist-led education, patient education, and medication reviews may increase the rates of discontinuing benzodiazepines and related sedative-hypnotic drugs compared with usual care.
In one trial of 301 patients, a pharmacist-led educational intervention was associated with 491 more discontinuations per 1,000 patients. Patient education led to 144 additional discontinuations per 1,000 patients across eight trials with 4,055 patients, and medication review was linked to 104 more discontinuations per 1,000 patients in two trials including 736 patients.
Moderate-certainty evidence suggested that patient education probably had little or no impact on physical function, mental health, or insomnia symptoms. Similar outcomes were not reported for for pharmacist-led interventions or medication reviews.
“Low certainty evidence suggests that, compared with usual care, education of patients, medication review, and a pharmacist led educational intervention may increase the proportion of patients who discontinue benzodiazepines and related sedative-hypnotic drugs (BSH),” said lead researcher Dena Zeraatkar, PhD, from the Department of Health Research Methods, Evidence, and Impact at McMaster University,
The meta-analysis evaluated interventions for adults patients using BSH for insomnia, such as benzodiazepines (such as diazepam and alprazolam) and non-benzodiazepine hypnotics (such as zolpidem and zaleplon). These medications are associated with adverse effects including cognitive decline, dependence, and falls, particularly among older adults.
Tapering alone, assessed in six trials with 1,122 patients, may also support discontinuation, although the absolute effect did not meet the prespecified threshold for clinical importance. For example, three trials involving 735 participants showed 74 more discontinuations per 1,000 patients. Low-certainty evidence also suggested that tapering may worsen physical function and quality of life, and likely has little or no effect on anxiety or depression.
Cognitive behavioral therapy (CBT), analyzed in 11 trials with 1,930 patients, showed uncertain effects. Eight of these trials compared CBT with usual care in 1,472 patients and found 71 more discontinuations per 1,000, but the certainty of evidence was very low. CBT likely had little or no impact on insomnia symptoms or sleep efficiency.
Multicomponent interventions, such as combining tapering with education or CBT, may be more effective than single-component approaches, although the certainty of evidence remains low. No intervention type was associated with an increased dropout rate.
All trials were conducted in high-income countries, and the median follow-up duration was 24 weeks. Across studies, 31.9% of participants were male, and the average age was 54 years. Most trials were conducted in community settings, and 35 were funded by government agencies.
The findings suggest certain strategies may support BSH deprescribing efforts, but further high-quality studies are needed to determine the most effective strategies.
Full disclosures can be found in the published study.
Source: thebmj