Reducción gradual de dosis frente a deprescripción abrupta de antipsicóticos en pacientes con demencia: una revisión sistemática

Objective: To synthesize the available evidence on antipsychotic gradual dose reduction or abrupt deprescription in the older people population with dementia. Methods: A systematic review of intervention studies. PubMed, Embase, Web of Science-Core Collection, Cochrane Library, Scopus, MEDLINE(Ovid), and PsycINFO databases were consulted. Articles were eligible for inclusion if they were intervention studies (randomized or quasi-experimental trials) evaluating the effectiveness of dose reduction or complete withdrawal antipsychotic deprescribing strategies in people with dementia. The screening process, data extraction, data analysis and bias risk assessment were performed by two independent reviewers and any discrepancies were triangulated with a third reviewer. Results: Eight clinical trials were ultimately included in the systematic review, two of which were quasi experimental. Over 60% of participants came from nursing or care homes. There is evidence of several strategies for deprescribing antipsychotics. Five studies used an abrupt withdrawal schedule and three studies used a gradual dose reduction. Deprescription through abrupt and gradual withdrawal schedules showed no significant differences in the management of behavioral symptoms, although abrupt withdrawals showed significantly higher rates of relapse and/or adverse events. Conclusion: Deprescribing antipsychotics is feasible in those people with dementia, and it is associated with benefits in terms of survival, and with potential improved outcomes in the management and relapse of behavioral and psychological symptoms of dementia. It seems reasonable that tapering off antipsychotic medication should be assessed after 12 weeks of treatment or when behavioural symptoms are under control.