Peter J. C. Stuijt, Stijn Crutzen, Mette Heringa, Jessica V. Hootsen, Barbara C. van Munster, Anita T. Wildeboer, Katja Taxis, Petra Denig
Background
Knowing whether patients' attitudes towards deprescribing differ by medication is important for implementing deprescribing in practice.
Objective
To assess whether there are within-patient differences in attitudes towards deprescribing the following cardiovascular and diabetes medications: statins, antihypertensives, sulfonylureas and insulins.
Methods
We administered the revised Patient Attitudes Towards Deprescribing questionnaire to Dutch primary care patients. The ‘appropriateness’ and ‘concerns’ factors were adapted to measure medication-specific attitudes. Pairwise comparisons of appropriateness and concerns factor scores were tested with Wilcoxon signed-rank tests and corrected to control the false discovery rate.
Results
Responses from 160 patients (median age: 79 years, 34% frail) were used for the comparisons. Appropriateness factor scores were higher for insulins compared to statins (n = 18, 3.9 versus 3.3, p < 0.031), antihypertensives (n = 21, 4.0 versus 3.6, p < 0.031) and sulfonylureas (n = 12, 3.8 versus 3.4, p < 0.031) and higher for sulfonylureas compared to antihypertensives (n = 26, 3.6 versus 3.4, p = 0.036) and statins (n = 27, 3.6 versus 3.2, p = 0.006). No statistical differences were found for the concerns factor scores.
Conclusion
Given the observed differences in appropriateness attitudes, patients may be more positive towards deprescribing statins and antihypertensives as compared to sulfonylureas and particularly insulins. Healthcare providers should be aware that patients can experience medication-specific barriers when discussing options for deprescribing.
{"title":"Patients' Attitudes Towards Deprescribing Differ Across Specific Cardiovascular and Diabetes Medication: A Survey Study Assessing Within-Patient Differences","authors":"Peter J. C. Stuijt, Stijn Crutzen, Mette Heringa, Jessica V. Hootsen, Barbara C. van Munster, Anita T. Wildeboer, Katja Taxis, Petra Denig","doi":"10.1111/bcpt.70140","DOIUrl":"10.1111/bcpt.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Knowing whether patients' attitudes towards deprescribing differ by medication is important for implementing deprescribing in practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether there are within-patient differences in attitudes towards deprescribing the following cardiovascular and diabetes medications: statins, antihypertensives, sulfonylureas and insulins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We administered the revised Patient Attitudes Towards Deprescribing questionnaire to Dutch primary care patients. The ‘appropriateness’ and ‘concerns’ factors were adapted to measure medication-specific attitudes. Pairwise comparisons of appropriateness and concerns factor scores were tested with Wilcoxon signed-rank tests and corrected to control the false discovery rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Responses from 160 patients (median age: 79 years, 34% frail) were used for the comparisons. Appropriateness factor scores were higher for insulins compared to statins (<i>n</i> = 18, 3.9 versus 3.3, <i>p</i> < 0.031), antihypertensives (<i>n</i> = 21, 4.0 versus 3.6, <i>p</i> < 0.031) and sulfonylureas (<i>n</i> = 12, 3.8 versus 3.4, <i>p</i> < 0.031) and higher for sulfonylureas compared to antihypertensives (<i>n</i> = 26, 3.6 versus 3.4, <i>p</i> = 0.036) and statins (<i>n</i> = 27, 3.6 versus 3.2, <i>p</i> = 0.006). No statistical differences were found for the concerns factor scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Given the observed differences in appropriateness attitudes, patients may be more positive towards deprescribing statins and antihypertensives as compared to sulfonylureas and particularly insulins. Healthcare providers should be aware that patients can experience medication-specific barriers when discussing options for deprescribing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bcpt.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The three-finger neurotoxins interfere with cholinergic transmission at various postsynaptic sites in the peripheral and central nervous systems. Based on receptor selectivity, the neurotoxins can be broadly classified as α-neurotoxins, k-neurotoxins and muscarinic toxins. The three-finger neurotoxins are nonenzymatic and possess a conserved structural feature consisting of loops of β-stranded loops protruding from a globular hydrophobic core held together by conserved disulfide bonds. The snake venom neurotoxins were first reported approximately 60 years ago, and their discovery has since expanded our knowledge of membrane receptors and ion channels. The interactions of these neurotoxins with receptors are of special interest for their potential use in the treatment of neurodegenerative diseases, pain and cancer. This review focuses on the snake venom neurotoxins and neurotoxin-like proteins and their subtypes, structural aspects of their mechanisms of action and specificity for receptors or ligand-binding interfaces. Further, a detailed discussion is added on the pharmacological potential of these toxins for use as probes or potential targets in drug discovery.
{"title":"Snake Venom Three-Finger Neurotoxins and Neurotoxin-Like Proteins: Insights Into Their Structural and Functional Aspects Along With Their Pharmacological Potential","authors":"Manisha Choudhury, Manas Das","doi":"10.1111/bcpt.70144","DOIUrl":"10.1111/bcpt.70144","url":null,"abstract":"<p>The three-finger neurotoxins interfere with cholinergic transmission at various postsynaptic sites in the peripheral and central nervous systems. Based on receptor selectivity, the neurotoxins can be broadly classified as α-neurotoxins, k-neurotoxins and muscarinic toxins. The three-finger neurotoxins are nonenzymatic and possess a conserved structural feature consisting of loops of β-stranded loops protruding from a globular hydrophobic core held together by conserved disulfide bonds. The snake venom neurotoxins were first reported approximately 60 years ago, and their discovery has since expanded our knowledge of membrane receptors and ion channels. The interactions of these neurotoxins with receptors are of special interest for their potential use in the treatment of neurodegenerative diseases, pain and cancer. This review focuses on the snake venom neurotoxins and neurotoxin-like proteins and their subtypes, structural aspects of their mechanisms of action and specificity for receptors or ligand-binding interfaces. Further, a detailed discussion is added on the pharmacological potential of these toxins for use as probes or potential targets in drug discovery.</p>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bcpt.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145501904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathrine Bohn Faldborg, Lambert Kristiansen Sørensen, Jørgen Bo Hasselstrøm, Charlotte Uggerhøj Andersen
Gamma-hydroxybutyric acid (GHB), a potential agent in drug-facilitated sexual assault, is difficult to detect due to rapid elimination, endogenous presence, and possible postsampling formation. We conducted a randomised, placebo-controlled trial in 30 healthy volunteers, administering 50-mg/kg sodium oxybate or placebo, to investigate symptoms, pharmacokinetics and endogenous concentrations. Blood was collected in fluoride-oxalate (FX) tubes, and urine and oral fluid in additive-free tubes, at baseline, 1, 2, 3, 4, 6, 12, and 24 (urine only) hours post-administration. Samples were immediately cooled, stored at −70°C, and analysed using LC–MS/MS. Maximal endogenous GHB concentrations were 0.050 μg/mL in blood, 0.41 μg/mL in urine, and 0.93 μg/mL in oral fluid. GHB-treated participants reported vertigo and fatigue, with no significant memory impairment. Median peak GHB concentrations post-administration were 50, 440, and 29 μg/mL in blood, urine, and oral fluid, respectively. Oral fluid appeared unsuitable for GHB detection. As endogenous concentrations in blood did not exceed 0.050 μg/mL, a theoretical cut-off with a safety margin (0.25 μg/mL) would yield a negligible risk of false positives in samples collected in FX tubes and cooled immediately. Applying this cut-off extended the blood detection window ≥ 2 h in all GHB-treated participants, surpassing that in urine at a 6-μg/mL cut-off.
{"title":"Endogenous Levels, Detection Time, and Symptoms of Gamma-Hydroxybutyric Acid: Results From a Placebo-Controlled Clinical Trial","authors":"Kathrine Bohn Faldborg, Lambert Kristiansen Sørensen, Jørgen Bo Hasselstrøm, Charlotte Uggerhøj Andersen","doi":"10.1111/bcpt.70133","DOIUrl":"https://doi.org/10.1111/bcpt.70133","url":null,"abstract":"<p>Gamma-hydroxybutyric acid (GHB), a potential agent in drug-facilitated sexual assault, is difficult to detect due to rapid elimination, endogenous presence, and possible postsampling formation. We conducted a randomised, placebo-controlled trial in 30 healthy volunteers, administering 50-mg/kg sodium oxybate or placebo, to investigate symptoms, pharmacokinetics and endogenous concentrations. Blood was collected in fluoride-oxalate (FX) tubes, and urine and oral fluid in additive-free tubes, at baseline, 1, 2, 3, 4, 6, 12, and 24 (urine only) hours post-administration. Samples were immediately cooled, stored at −70°C, and analysed using LC–MS/MS. Maximal endogenous GHB concentrations were 0.050 μg/mL in blood, 0.41 μg/mL in urine, and 0.93 μg/mL in oral fluid. GHB-treated participants reported vertigo and fatigue, with no significant memory impairment. Median peak GHB concentrations post-administration were 50, 440, and 29 μg/mL in blood, urine, and oral fluid, respectively. Oral fluid appeared unsuitable for GHB detection. As endogenous concentrations in blood did not exceed 0.050 μg/mL, a theoretical cut-off with a safety margin (0.25 μg/mL) would yield a negligible risk of false positives in samples collected in FX tubes and cooled immediately. Applying this cut-off extended the blood detection window ≥ 2 h in all GHB-treated participants, surpassing that in urine at a 6-μg/mL cut-off.</p>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bcpt.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Westberg Strejby Christensen, Kim Peder Dalhoff, Esben Iversen, Helle Gybel Juul-Larsen, Line Jee Hartmann Rasmussen, Aino Leegaard Andersen, Ove Andersen, Morten Baltzer Houlind
The prevalence of medication-related admissions (MRAs) among older medical patients admitted to Danish emergency departments (EDs) remains limited. We aimed to determine the prevalence of possibly medication-related admissions (PMRAs) in this population, assess their preventability and identify patient characteristics that distinguish between patients with and without a PMRA. This retrospective, exploratory, descriptive secondary analysis included acutely admitted older medical patients (≥ 65 years) from the ED of Copenhagen University Hospital Hvidovre, Denmark, between October 2018 and April 2021. PMRAs were initially assessed using the Assessment Tool for Hospital Admissions Related to Medications, followed by final classifications and preventability assessments by an experienced panel of pharmacists and a pharmacologist. Among 193 admissions, 31 (16.1%) were classified as PMRAs, and 15 (48.4%) and 11 (35.5%) of these were deemed potentially or definitely preventable, respectively. Untreated conditions (19.4%) and miscommunication (16.1%) were identified as the most common reasons for PMRAs. No specific patient characteristics reliably distinguished between patients with and without a PMRA. In conclusion, MRAs appear to be highly prevalent in Danish EDs, emphasising the need for improved identification and prevention strategies.
{"title":"Medication-Related Admissions Among Older Patients in a Danish Emergency Department: Prevalence, Preventability and Characterisation","authors":"Louise Westberg Strejby Christensen, Kim Peder Dalhoff, Esben Iversen, Helle Gybel Juul-Larsen, Line Jee Hartmann Rasmussen, Aino Leegaard Andersen, Ove Andersen, Morten Baltzer Houlind","doi":"10.1111/bcpt.70132","DOIUrl":"10.1111/bcpt.70132","url":null,"abstract":"<div>\u0000 \u0000 <p>The prevalence of medication-related admissions (MRAs) among older medical patients admitted to Danish emergency departments (EDs) remains limited. We aimed to determine the prevalence of possibly medication-related admissions (PMRAs) in this population, assess their preventability and identify patient characteristics that distinguish between patients with and without a PMRA. This retrospective, exploratory, descriptive secondary analysis included acutely admitted older medical patients (≥ 65 years) from the ED of Copenhagen University Hospital Hvidovre, Denmark, between October 2018 and April 2021. PMRAs were initially assessed using the Assessment Tool for Hospital Admissions Related to Medications, followed by final classifications and preventability assessments by an experienced panel of pharmacists and a pharmacologist. Among 193 admissions, 31 (16.1%) were classified as PMRAs, and 15 (48.4%) and 11 (35.5%) of these were deemed potentially or definitely preventable, respectively. Untreated conditions (19.4%) and miscommunication (16.1%) were identified as the most common reasons for PMRAs. No specific patient characteristics reliably distinguished between patients with and without a PMRA. In conclusion, MRAs appear to be highly prevalent in Danish EDs, emphasising the need for improved identification and prevention strategies.</p>\u0000 </div>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianbing Wu, Zhangchao Guo, Xiaohuan He, Liyuan Yang, Jie Zhang, Lijuan Shu, Chunfu Du
Background
Bergaptol has demonstrated various pharmacological activities, including antitumor, anti-inflammatory and neuroprotective effects. However, its therapeutic potential and underlying mechanisms in intracerebral haemorrhage (ICH) remain elusive.
Methods
ICH mice were treated with a daily intraperitoneal injection of bergaptol (20 or 40 mg/kg) for five consecutive days. Neurological function was assessed using the Garcia score; brain edema was measured by the wet/dry weight method. The expressions of NeuN and Iba1 were detected by immunofluorescence staining. The levels of oxidative stress markers (SOD, CAT and MDA) and pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) were measured by ELISA. Furthermore, the phosphorylation levels of JAK2, STAT3 and NF-κB p65 were determined by Western blotting. The Morris Water Maze (MWM) test was conducted to assess long-term neurological function, and hippocampal neuronal dendritic spines were visualized using Golgi-Cox staining.
Results
The results showed that bergaptol dose-dependently improved neurological function, attenuated acute cerebral edema, alleviated the reduction of perihematomal cortical neurons, and prevented the loss of hippocampal neuronal dendritic spines in experimental ICH. Mechanistically, bergaptol alleviated oxidative stress and inflammation, potentially by inhibiting the JAK2/STAT3 and NF-κB signaling pathways.
Conclusions
Bergaptol attenuated oxidative stress and inflammation while improving neurological function in a mouse model of ICH, potentially through modulation of the JAK2/STAT3 and NF-κB signaling pathways.
{"title":"Bergaptol Alleviates Oxidative Stress and Inflammation in Intracerebral Haemorrhage Mice via JAK2/STAT3 and NF-κB Pathways, Improving Neurological Function","authors":"Jianbing Wu, Zhangchao Guo, Xiaohuan He, Liyuan Yang, Jie Zhang, Lijuan Shu, Chunfu Du","doi":"10.1111/bcpt.70135","DOIUrl":"https://doi.org/10.1111/bcpt.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bergaptol has demonstrated various pharmacological activities, including antitumor, anti-inflammatory and neuroprotective effects. However, its therapeutic potential and underlying mechanisms in intracerebral haemorrhage (ICH) remain elusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ICH mice were treated with a daily intraperitoneal injection of bergaptol (20 or 40 mg/kg) for five consecutive days. Neurological function was assessed using the Garcia score; brain edema was measured by the wet/dry weight method. The expressions of NeuN and Iba1 were detected by immunofluorescence staining. The levels of oxidative stress markers (SOD, CAT and MDA) and pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) were measured by ELISA. Furthermore, the phosphorylation levels of JAK2, STAT3 and NF-κB p65 were determined by Western blotting. The Morris Water Maze (MWM) test was conducted to assess long-term neurological function, and hippocampal neuronal dendritic spines were visualized using Golgi-Cox staining.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results showed that bergaptol dose-dependently improved neurological function, attenuated acute cerebral edema, alleviated the reduction of perihematomal cortical neurons, and prevented the loss of hippocampal neuronal dendritic spines in experimental ICH. Mechanistically, bergaptol alleviated oxidative stress and inflammation, potentially by inhibiting the JAK2/STAT3 and NF-κB signaling pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bergaptol attenuated oxidative stress and inflammation while improving neurological function in a mouse model of ICH, potentially through modulation of the JAK2/STAT3 and NF-κB signaling pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reversible cholinesterase inhibitors have been investigated to address prophylactic and therapeutic outcomes against organophosphorus nerve poisoning, and procyclidine is concomitantly used to compensate for their adverse effects. We designed double-layer patches with microneedles composed of a cream layer for immediate release and a hyaluronic acid–based thin solid layer for sustained release. Rivastigmine and procyclidine were added to the two layers with different doses, and their transdermal absorption was explored in guinea pigs for the first time. The contents of hyaluronic acid and the number of microneedles were also examined to determine the optimal patches, which would achieve the mean target plasma concentrations of the two drugs for 72 h. Plasma concentrations of rivastigmine and procyclidine were determined using a validated HPLC–MS/MS method, and acetylcholinesterase (AChE) activity was monitored and correlated with plasma rivastigmine concentrations. The systemic exposure of both drugs was successfully characterised in guinea pigs, and the change was relevant in terms of different patches with microneedles. The inhibitory effect on AChE was prolonged despite the decay of rivastigmine concentrations. Finally, the preparation of a double-layer patch with microneedles was suggested, and the present results would help explain the prophylactic and therapeutic effects of rivastigmine and procyclidine against biochemical weapons.
{"title":"Pharmacokinetics of Double-Layer Patches With Microneedles Containing Procyclidine and Rivastigmine in Guinea Pigs","authors":"Minsun Moon, Jihyun Won, Yun-Woo Lee, Sohee Jeon, Yoosik Yoon, Jun-Ho Jeong, Wonku Kang","doi":"10.1111/bcpt.70134","DOIUrl":"10.1111/bcpt.70134","url":null,"abstract":"<p>Reversible cholinesterase inhibitors have been investigated to address prophylactic and therapeutic outcomes against organophosphorus nerve poisoning, and procyclidine is concomitantly used to compensate for their adverse effects. We designed double-layer patches with microneedles composed of a cream layer for immediate release and a hyaluronic acid–based thin solid layer for sustained release. Rivastigmine and procyclidine were added to the two layers with different doses, and their transdermal absorption was explored in guinea pigs for the first time. The contents of hyaluronic acid and the number of microneedles were also examined to determine the optimal patches, which would achieve the mean target plasma concentrations of the two drugs for 72 h. Plasma concentrations of rivastigmine and procyclidine were determined using a validated HPLC–MS/MS method, and acetylcholinesterase (AChE) activity was monitored and correlated with plasma rivastigmine concentrations. The systemic exposure of both drugs was successfully characterised in guinea pigs, and the change was relevant in terms of different patches with microneedles. The inhibitory effect on AChE was prolonged despite the decay of rivastigmine concentrations. Finally, the preparation of a double-layer patch with microneedles was suggested, and the present results would help explain the prophylactic and therapeutic effects of rivastigmine and procyclidine against biochemical weapons.</p>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 5","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonas W. Wastesson, Karl-Hermann Sielinou Kamgang, Carina Lundby, Anton Pottegård
<p>In routinely collected healthcare data, deprescribing is in most cases indistinguishable from drug discontinuation. This is not a minor technical challenge; it is a fundamental limitation in most routinely collected data sources, such as dispensing data, electronic health records and registries. Deprescribing is only a subset of discontinuation, defined by its intentionality, clinical supervision and patient perspective: ‘Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes’ [<span>1</span>]. Supervision by clinicians and goal-setting with patients are defining features, yet they remain invisible in routinely collected data. Any attempt to identify deprescribing without acknowledging this constraint risks conflating clinical decision-making with other reasons for discontinuation such as patient adherence issues. This paper reflects on how creative use of routinely collected data may nevertheless further our understanding of the impact of deprescribing and, on occasion, allow distinguishing deprescribing from other forms of discontinuation.</p><p>There is a need for observational studies in deprescribing research. Large-scale deprescribing trials are unlikely, as most trials depend on pharmaceutical industry funding and deprescribing lacks commercial incentive. Hence, registry studies (routinely collected administrative health care data) remain one of the few options for studying deprescribing at scale [<span>2</span>]. Although this function is constrained by the inability to distinguish deprescribing from other forms of discontinuation in routinely collected data, creative use of data and design can overcome some challenges.</p><p>We acknowledge calls for stricter conceptual clarity in the use of the term deprescribing, emphasizing shared decision-making and structured follow-up [<span>3</span>]. This definition is typically achievable in intervention studies. However, in pharmacoepidemiologic research, such detailed process elements are rarely observable. If conceptual criteria were applied rigidly, most register-based studies would be excluded from deprescribing research. We take a more pragmatic view. When the aim is to study deprescribing, even without full access to process details, it is reasonable to use the term, provided the operational definition is clearly stated and its limitations acknowledged. This allows the research to stay conceptually focused while contributing to the broader evidence base.</p><p>The challenges of identifying deprescribing are not new to the field of pharmacoepidemiology and can be summarized as below.</p><p>The key challenges of identifying deprescribing should not discourage researchers from studying this in routinely collected data. Rather, we argue that careful use of data can move the deprescribing field forward.</p><p>An alternative to the approach of enriching data is to find exa
{"title":"Studying Deprescribing Using Routinely Collected Healthcare Data: Old Challenges and New Opportunities","authors":"Jonas W. Wastesson, Karl-Hermann Sielinou Kamgang, Carina Lundby, Anton Pottegård","doi":"10.1111/bcpt.70131","DOIUrl":"10.1111/bcpt.70131","url":null,"abstract":"<p>In routinely collected healthcare data, deprescribing is in most cases indistinguishable from drug discontinuation. This is not a minor technical challenge; it is a fundamental limitation in most routinely collected data sources, such as dispensing data, electronic health records and registries. Deprescribing is only a subset of discontinuation, defined by its intentionality, clinical supervision and patient perspective: ‘Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes’ [<span>1</span>]. Supervision by clinicians and goal-setting with patients are defining features, yet they remain invisible in routinely collected data. Any attempt to identify deprescribing without acknowledging this constraint risks conflating clinical decision-making with other reasons for discontinuation such as patient adherence issues. This paper reflects on how creative use of routinely collected data may nevertheless further our understanding of the impact of deprescribing and, on occasion, allow distinguishing deprescribing from other forms of discontinuation.</p><p>There is a need for observational studies in deprescribing research. Large-scale deprescribing trials are unlikely, as most trials depend on pharmaceutical industry funding and deprescribing lacks commercial incentive. Hence, registry studies (routinely collected administrative health care data) remain one of the few options for studying deprescribing at scale [<span>2</span>]. Although this function is constrained by the inability to distinguish deprescribing from other forms of discontinuation in routinely collected data, creative use of data and design can overcome some challenges.</p><p>We acknowledge calls for stricter conceptual clarity in the use of the term deprescribing, emphasizing shared decision-making and structured follow-up [<span>3</span>]. This definition is typically achievable in intervention studies. However, in pharmacoepidemiologic research, such detailed process elements are rarely observable. If conceptual criteria were applied rigidly, most register-based studies would be excluded from deprescribing research. We take a more pragmatic view. When the aim is to study deprescribing, even without full access to process details, it is reasonable to use the term, provided the operational definition is clearly stated and its limitations acknowledged. This allows the research to stay conceptually focused while contributing to the broader evidence base.</p><p>The challenges of identifying deprescribing are not new to the field of pharmacoepidemiology and can be summarized as below.</p><p>The key challenges of identifying deprescribing should not discourage researchers from studying this in routinely collected data. Rather, we argue that careful use of data can move the deprescribing field forward.</p><p>An alternative to the approach of enriching data is to find exa","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 5","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristen M. Kraemer, Brianna Wang, Marissa McCann, Julia Lindenberg, Timothy S. Anderson, Gloria Y. Yeh
Benzodiazepines are potentially inappropriate medications for older adults, and deprescribing interventions are needed. We describe the development of a psychologist-led, mindfulness-informed cognitive–behavioural therapy (CBT) intervention to pair with pharmacist-led tapering to support benzodiazepine deprescribing in older adults. Based on previous research, we first developed an intervention conceptual model. The aim of this study was to (1) gather stakeholder feedback on previous experiences with benzodiazepine tapering and on our intervention model and proposed intervention, and (2) integrate this qualitative feedback to develop an intervention manual. We conducted (a) semistructured individual interviews with older adults (N = 8) who previously attempted to taper their benzodiazepines, and (b) a focus group with members (N = 5) from a national deprescribing patient stakeholder group. Overlapping themes emerged, including support for the mindfulness-informed CBT intervention, the importance of control over taper pace, the need for a goal- and skills-oriented intervention, the importance of normalizing side effects of the taper and building confidence to manage side effects and the utility of fostering acceptance during the taper. These findings informed the development of a final intervention manual, named Confidence-Building Strategies for Reducing Sedative Medications (CSTARS), to be tested in a single-arm pilot feasibility trial.
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