The authors of a related Commentary note that cessation of statin therapy in patients with a limited life expectancy has been advocated as a relatively straightforward decision; little however is known about barriers to this. Clinicians may be uncertain about the benefits and harms of discontinuing the therapy, especially if the patient has been receiving the medication for a long time without adverse effects.
The results of this study suggest that both withdrawing and continuing statin therapy are reasonable alternatives in advanced illness and in the absence of recent cardiovascular events. As neither strategy was clearly superior to the other, discussions about discontinuing therapy should occur in the context of shared decision making with a focus on patient and caregiver preference.
Although the proportion of participants who died within 60 days (primary endpoint) was not significantly different between groups (23.8% of the discontinuation group vs 20.3% of the continuation group; 90% CI -3.5% to 10.5%; p=0.36), the study did not meet its objective of demonstrating non-inferiority of deprescribing to continued prescribing. This is because the upper confidence limit for the difference in proportion of participants who died within 60 days (10.5%) exceeded the non-inferiority margin of 5%.
The authors discuss further potential limitations of their study, including the lack of power when assessing various endpoints, the lack of blinding (which could for bias toward identification of more adverse consequences of discontinuing therapy), the enrolment only of those willing to be randomised to discontinuation, and those for whom the physician was willing (which may lead to a possible bias towards patients in whom it would be safer to discontinue statins).
A related article (see link below) on deprescribing proposes five essential steps in the decision-making process and presents multiple strategies by which deprescribing could be facilitated in clinical practice, incorporated into research protocols, developed into guidelines, integrated into educational interventions, and included in policy initiatives.