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 Among people without active heart disease who were expected to live
no more than a year, stopping the drugs, known as statins, didn’t
increase the number of deaths within 60 days, but did improve
quality of life. Stopping the drugs also reduced costs.
“We start a lot of medicines, and many of these medicines come with
the tagline that ‘you’ll be taking these medicines for the rest of
your life,’” said Dr. Amy Abernethy, the study’s senior author from
the Duke University School of Medicine in Durham, North Carolina.
“They start to stack up, but we don’t have a thoughtful way to stop
them,” she told Reuters Health in a phone interview.
Statins work by blocking a substance the body needs to make
cholesterol, which can build up in arteries and ultimately cause
heart attacks and strokes. Popular statins include Pfizer’s Lipitor,
sold generically as atorvastin, and Merck’s Zocor, sold generically
as simvastatin.
The researchers write in JAMA Internal Medicine that drug trials
rarely address the issue of when to stop using the treatments. The
topic becomes especially important as the body responds differently
to drugs later in life.
Statins are considered candidates for so-called deprescribing at the
end of life, because their benefit - a lower risk of heart disease -
isn't seen for about two years, they write.
The researchers recruited 381 people who were not expected to live
for more than a year. Their average age was 74, and they'd been
taking statins for at least three months. They did not have active
heart disease. About a fifth were cognitively impaired and about
half had cancer.
About half the participants were randomly assigned to stop taking
statins. Overall, about 24 percent died within 60 days, but that was
not significantly different from the 20 percent who died in the
group that kept taking the drugs.
The group that stopped taking the drugs did have a small improvement
in their quality of life scores, compared to those who continued to
take the medications, the researchers found.
Abernethy said they can’t say why quality of life scores increased,
but it could be because patients interpreted the discussions
surrounding deprescribing medications as doctors paying more
attention to their healthcare needs.
She said stopping statins was also linked to stopping other
medications per doctors' instructions, which may occur when doctors
find that it’s safe to stop certain drugs. It may also be that drugs
to control statin side effects were no longer needed.
They also found that stopping statins among people who were close to
death saved about $4 per day, or about $716 per patient.
“We hope the way the data will be used is a part of doctors being
able to have more confident conversations between patients and
families,” Abernethy said.
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While it's typically difficult to draw conclusions when looking for
deaths among a group of people, Dr. Andrew E. Moran from Columbia
University Medical Center said it's appropriate for this trial.
"Because the survival is so poor in these very ill people, it’s not
unreasonable to recruit a fairly small sample size because the
probability of adverse events and death is very high in these
patients," said Moran, who was not involved with the new study.
He also said that doctors typically consider people's life
expectancy and possible benefits when deciding whether to continue
treating them with statins.
For some doctors, pharmacists and even patients and their families,
the new evidence may show it's OK to discontinue some therapies at
the end of life.
"I think it’s not just for physicians but patients and family
members," Moran said.
Researchers suggest a five-step plan for evaluating and
deprescribing medications in an article also published in JAMA
Internal Medicine.
The five-step plan includes finding all the medications a person is
taking, considering the risk of taking the drugs, evaluating the
possibility of discontinuing each drug, prioritize which drugs to
stop and then stopping medications while monitoring the patient.
More research is needed to determine which patients would benefit
most from having some of their medications stopped, write the
authors, led by Dr. Ian Scott from the Princess Alexandra Hospital
in Brisbane, Australia.
In a commentary, Dr. Holly Holmes of the University of Texas MD
Anderson Cancer Center and Adam Todd from the Durham University in
England say similar research should be done on preventive treatments
for diabetes, high blood pressure and other chronic conditions.
SOURCE: http://bit.ly/1B9QvhK
http://bit.ly/1B9QDxG and
http://bit.ly/1B9QIBA JAMA
Internal Medicine, online March 23, 2015.
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