Types of potentially inappropriate medications (PIMs) classes targeted by deprescribing tools and interventions: a systematic reivew

Introduction: Polypharmacy can lead to drug-related problems (DRPs) and interactions, often involving potentially inappropriate medications (PIMs). PIMs can be identified and, when appropriate, deprescribed using various tools/interventions; however, gaps remain regarding the suitability and effectiveness of specific tools for different medication classes.
Aims/Objectives: This systematic review aimed to identify types of medication classes targeted by deprescribing tools, as well as the most frequently applied deprescribing tools and interventions.
Methods: Four databases (Embase, PubMed, Scopus, Medline) were searched for observational studies (OSs) and randomised control trials (RCTs) (2010–2023) reporting the application of deprescribing tools to detect/deprescribe PIMs. Keywords and MeSH terms (e.g., "polypharmacy", "deprescribing"), linked with Boolean operators. Results were summarised narratively and descriptively. Medications were classified by shared inappropriateness (e.g., risk of fall) and physiological body systems.
Results: Eighty-two studies (n=58 OSs, n=24 RCTs) were included. A total of 44 deprescribing tools/interventions were identified, including 24 unique interventions applied in the 24 RCTs. In total, 74 targeted medication classes were identified (239 active substances) and categorised into 11 groups. The most common groups included Frailty-increasing drugs (FIDs) (36 classes), Fall risk-increasing drugs (FRIDs) (n=35), drugs with major/minor anticholinergic properties (DMAPs) (n=31), cardiovascular drugs (n=19), and psychotropics (n=14), based on the number of classes within each group. The top 10 targeted PIMs based on the detection frequency included alpha-receptor blockers (detected 33 times), proton pump inhibitors (n=27), statins (n=22), calcium/vitamin D supplements (n=21), and antidiabetics (n=19). The most commonly applied deprescribing tools were STOPP (n=17 (20.2%)), Beer’s criteria (n=13 (15.4%)), STOPPFrail (n=11 (13.1%)), and STOPPFall (n=6 (4.7%)).
Discussion/Conclusion: Deprescribing tools target a wide range of medication classes, with frailty- and fall risk-increasing drugs (detected by STOPPFrail and STOPPFall) being the most frequently addressed. Despite diverse tools and targeted medications, standardisation and further research are needed to optimise their clinical effectiveness.