N‐of‐1 trials to facilitate evidence‐based deprescribing: Rationale and case study. Issue 10 (13th July 2022)

• Record Type: Journal Article
• Authors: Goyal, Parag; Safford, Monika M.; Hilmer, Sarah N.; Steinman, Michael A.; Matlock, Daniel D.; Maurer, Mathew S.; Lachs, Mark S.; Kronish, Ian M.
• Other Names: Gacia‐Bournissen Facundo guestEditor.; Rieder Michael guestEditor.
• Is Part Of: British journal of clinical pharmacology. Volume 88:Issue 10(2022)
• Page Start: 4460
• Page End: 4473
• Publication Date: 2022-07-13
• Subjects: beta‐blockers -- deprescribing -- N‐of‐1 -- personalized medicine; Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.15442
• Languages: English
• ISSNs: 0306-5251

Abstract

Abstract : Deprescribing has emerged as an important aspect of patient‐centred medication management but is vastly underutilized in clinical practice. The current narrative review will describe an innovative patient‐centred approach to deprescribing—N‐of‐1 trials. N‐of‐1 trials involve multiple‐period crossover design experiments conducted within individual patients. They enable patients to compare the effects of two or more treatments or, in the case of deprescribing N‐of‐1 trials, continuation with a current treatment versus no treatment or placebo. N‐of‐1 trials are distinct from traditional between‐patient studies such as parallel‐group or crossover designs which provide an average effect across a group of patients and obscure differences between individuals. By generating data on the effect of an intervention for the individual rather than the population, N‐of‐1 trials can promote therapeutic precision. N‐of‐1 trials are a particularly appealing strategy to inform deprescribing because they can generate individual‐level evidence for deprescribing when evidence is uncertain, and can thus allay patient and physician concerns about discontinuing medications. To illustrate the use of deprescribing N‐of‐1 trials, we share a case example of an ongoing series of N‐of‐1 trials that compare maintenance versus deprescribing of beta‐blockers in patients with heart failure with preserved ejection fraction. By providing quantifiable data on patient‐reported outcomes, promoting personalized pharmacotherapy, and facilitating shared decision making, N‐of‐1 trials represent a potentially transformative strategy to address polypharmacy.