Comparative effectiveness of interventions to facilitate deprescription of benzodiazepines and other sedative hypnotics: systematic review and meta-analysis

PMCID: PMC12171951

PMID: 40527546

DOI: 10.1136/bmj-2024-081336

Journal: BMJ (Clinical research ed.)

Publication Date: 2025

Authors: Zeraatkar D, Nagraj SK, Ling M, Jassal T, Kirsh S, et al.

Key Points

• Patient education and pharmacist-led interventions showed the most promise in facilitating BSH discontinuation
• Low-certainty evidence suggests 144 more patients per 1,000 might successfully discontinue BSH with patient education
• Multicomponent interventions may be more effective than single-component approaches in supporting medication deprescription

Summary

This systematic review and meta-analysis comprehensively evaluated interventions aimed at deprescribing benzodiazepines and sedative hypnotics (BSH) across 49 randomized trials involving over 39,000 patients. The research sought to identify effective strategies for discontinuing long-term BSH use, a critical issue in clinical practice given potential medication-related risks and dependency.

The analysis revealed low to moderate certainty evidence suggesting that patient education, medication reviews, and pharmacist-led educational interventions may modestly increase BSH discontinuation rates. Notably, most interventions showed limited effectiveness, with no compelling evidence supporting tapering, physician education, cognitive behavioral therapy, or drug-assisted withdrawal as consistently successful deprescribing strategies. The findings underscore the complexity of BSH discontinuation and highlight the need for nuanced, patient-centered approaches to medication management.