A comprehensive systematic review of the types of medication classes targeted by deprescribing tools and the tools/interventions applied to each class

Introduction: Polypharmacy and potentially inappropriate medications (PIMs) contribute to adverse outcomes. Deprescribing, the supervised withdrawal of PIMs, is a key strategy to reduce these risks. Identifying the most targeted PIMs and commonly used tools for deprescribing remains essential. The aim of this systematic review was to identify the medication classes targeted by deprescribing tools, stratified by tool type and frequency and to evaluate the availability of medication-specific tools. Methods: A systematic search of Embase, PubMed, Scopus, and Medline (2010–2023) identified observational and experimental studies using polypharmacy and deprescribing terms. The Newcastle-Ottawa Scale (NOS) and the revised Cochrane risk-of-bias tool (RoB 2) were used for quality assessment. Medication classes and tools/interventions were summarized in the TOTALLY TARGETED List. Results: Eighty-two studies identified 44 deprescribing tools targeting 77 medication classes. The top PIMs were benzodiazepines, antipsychotics, alpha-receptor blockers, proton pump inhibitors, and Z-hypnotics. The most used tools were Screening Tool of Older People’s Prescriptions (STOPP) Frail, American Geriatric Society (AGS) Beers Criteria, STOPP Criteria, and STOPPFall. Several medication-specific tools (e.g. PIMs in cognitively impaired patients) were also identified. Conclusion: This review identified the most targeted medication classes and deprescribing tools, emphasizing the need for medication-specific and patient-centered approaches to improve safety and outcomes. Protocol registration: https://www.crd.york.ac.uk/prospero//CRD42023442654.