NEW YORK(Reuters Health) - Taking dying people off cholesterol-lowering medications is safe and may actually improve quality of life, according to a new study.
Among people without active heart disease who were estimated to live no more than one year, stopping statins didn't increase the number of deaths within 60 days, but improved quality of life. Also, stopping the drugs 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.
The researchers write in an article published online March 23 in JAMA Internal Medicine that trials supporting the use of drugs rarely address when people should stop using the treatments. The topic becomes especially important as the body responds differently to drugs later in life.
Statins are considered candidates for "deprescribing" at the end of life, because the lower risk of heart disease doesn't happen for about two years, they write.
The researchers recruited 381 people who were not expected to live for more than one year. They were an average age of 74 years, had been on statins for at least three months and did not have active heart disease. About a fifth were cognitively impaired and about half had cancer.
About half of the group was randomly assigned to stop taking statins. Overall, about 24% died within 60 days, but that was not significantly different from the 20% who died among people who continued to take the drugs.
The group who 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 doctors stopping other medications, 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.
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 many physicians typically take in people's life expectancy and possible benefits into account when deciding whether to continue giving people statins.
For some doctors, pharmacists and even patients and their family members, the new evidence may show them 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 in how to evaluate 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 researchers led by Dr. Ian Scott from the Princess Alexandra Hospital in Brisbane, Australia.
In a commentary accompanying the two articles, the University of Texas MD Anderson Cancer Center's Dr. Holly Holmes and Adam Todd from the Durham University in England suggest similar research should be done on preventive treatments for diabetes, high blood pressure and other chronic conditions.
The National Institute of Nursing Research and the Veterans Affairs Health Care Systems supported this research. The authors report no disclosures.
SOURCE: http://bit.ly/1B9QvhK http://bit.ly/1B9QDxG and http://bit.ly/1B9QIBA
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