Background: Evidence gaps exist in medication effectiveness and safety for older adults due to the underrepresentation or exclusion of this population in randomised controlled trials (RCTs). Target trial emulation has emerged as a promising methodological approach to address these gaps by generating real-word evidence on medications comparative effectiveness and safety in older adults. Our systematic review aimed to identify deprescribing RCTs evaluating the effects of discontinuation on clinical outcomes to inform a deprescribing trial emulation using the Registry of Senior Australians, which is a national population-based data platform integrating aged care, health care and social welfare information.

Methods: Medline Ovid, EMBASE Ovid, Cochrane Library Special Collection on deprescribing, and clinical trial registration platforms from inception to 2022 were searched using the US Deprescribing Research Network deprescribing literature search strategy. RCTs that compared the effect of deprescribing modalities (abrupt discontinuation or down titration) on clinical outcomes in older adults (≥65 years) were included. Key RCT design parameters were extracted and mapped according to components of the target trial emulation framework. RCT characteristics are presented.

Results: 1131 studies were screened, 43 met the inclusion criteria and 9 were of ongoing and registered RCTs. The included RCTs covered many medication classes, including antipsychotics, antidepressants, dementia medications, heart failure medications, antihypertensives, and antiresorptive therapies. The outcomes included the effect of discontinuation on cognitive, functional, or neuropsychiatric outcomes, mortality, and institutionalisation.

Discussion: This systematic review informs ongoing efforts on database emulation of deprescribing trials using the ROSA data. Ongoing work is underway to ascertain the feasibility of the ROSA platform for the RCT emulation.

Other: This study was undertaken with the financial support of the South Australian Health and Medical Research Institute (SAHMRI) Early and Mid-Career Researcher Seed Funding Grant.