Today, 28% of Italians older than 65 years take more than 10 medications, and a significant proportion take as many as 20 or more. Data such as these have prompted the international community to focus on deprescribing, a topic also discussed during a workshop at the 42nd annual conference of the International Society for Pharmacoepidemiology (ISPE), held in Milan, Italy, from August 29 to September 2, 2026.

“In a scenario like this, we are not providing adequate care to patients because prescribing 20 medications to a patient is not the same as caring for that person,” Gianluca Trifirò , MD, told Univadis Italy, part of the Medscape Professional Network. Trifirò is a clinical pharmacologist, a professor of pharmacology at the University of Verona in Verona, Italy, and director of the Medication Review & Deprescribing Service at the Integrated University Hospital.

At the start of the workshop, Trifirò — who is also head of the scientific program for ISPE 2026 — said that “if a medication is not necessary, then it is harmful,” a statement that also applies to dietary supplements, substances that are increasingly popular but often prescribed without a real need, thereby increasing the number of substances a person takes. According to the expert, bringing this message to life requires a genuine cultural shift — one that is not easy to achieve for numerous reasons, ranging from organizational issues to the personal beliefs of doctors and patients, as well as the difficulty in obtaining data on the subject.

A Complex Topic to Define and Study

When discussing deprescribing, it is important to start with the definition. As Shanna Trenaman , PhD, assistant professor at College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada, explained during the workshop, the term deprescribing refers to “the systematic process of identifying and discontinuing medications in cases where the actual or potential harms outweigh the actual or potential benefits, within the context of care goals, current level of functioning, life expectancy, and the individual patient’s values and preferences.” This differs from treatment optimization, which is instead defined as “a person-centered approach to the safe and effective use of therapies, to ensure that the person achieves the best possible outcomes from drug treatment.”

Studying how and when to intervene and assessing the impact of deprescribing presents researchers with numerous methodological questions and concerns. Trenaman addressed some of these during her presentation, including the importance of selecting the observation window for evaluating treatment discontinuation, differences among patients, and the limitations of deprescribing studies that focus on a single target medication. The expert noted that the success of a deprescribing intervention is not measured solely in binary terms — whether a drug is taken or not — since dose reductions and tapering, that is, gradual reductions before discontinuation, can also be beneficial.

The Commitment of ISPE and Other Scientific Societies

Aware of these challenges, ISPE experts have devoted particular attention to the topic, an effort that led to the publication in 2025 of two documents sponsored by the society. Both were presented during the workshop by Daniela Moga , MD, PhD, of the University of Kentucky College of Pharmacy in Lexington, Kentucky.

The first, a systematic review based on 45 studies, aims to describe the methodologies currently used to assess the effects of deprescribing in older adults and to identify weaknesses and future opportunities. Among the methodological gaps identified by the study is the fact that 78% considered only complete discontinuation of treatment, while gradual dose reduction (tapering) was rarely taken into account. Furthermore, 27% never clearly defined the time of deprescribing, or “time zero,” and only four of 45 studies evaluated alternative definitions. Finally, 11% did not clearly describe the method used to control for confounding factors.

These data also serve as the starting point for the second document promoted by ISPE, which serves as a comprehensive guide comprising 23 recommendations, known by the acronym REMROSE-D (Reporting and Methodological Recommendations for Observational Studies estimating the Effects of Deprescribing medications).

Italy is also quite active on this issue, so much so that in 2023 an intersociety document on the implementation of medication review and deprescribing in various care setting was published with the aim of defining operational strategies for optimizing polypharmacy through precisely this type of intervention.

It is interesting to note that the research promoted by ISPE does not focus solely on methodology. Sri Harsha Chalasani , JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, India, presented the results of a project conducted in 11 countries with ISPE’s support, aimed at understanding the use and impact of patient-reported outcomes (PROs) in deprescribing for the older population. The article presents an analysis of data from 16 studies that used PROs, highlighting a certain level of patient satisfaction, but also limited generalizability of the results and, above all, the lack of an ad hoc tool to assess these factors. “A fundamental aspect of deprescribing is taking the patient’s perspective into account. To ensure the success of this process, it is necessary to emphasize empathy-based deprescribing,” Chalasani told Univadis Italy.

A 360-Degree Perspective

Chalasani remarks during the workshop, ISPE President Ursula Kirchmayer  described the benefits and challenges associated with deprescribing, broadening the perspective beyond patients to include healthcare providers and health systems as well.

The potential benefits are numerous: for patients, this means reducing the risk for drug interactions — which are not uncommon in highly complex regimens — reducing treatment-related adverse events, simplifying medication regimens, and consequently improving treatment adherence and quality of life. On the other hand, healthcare professionals can find support in managing polypharmacy in frail and older patients, while health systems can significantly reduce the costs associated with drug interactions and adverse events.

However, challenges abound: patients must trust the physician who proposes discontinuing treatment, understand the rationale behind this request, and overcome cultural barriers and social inequalities in access to and support for care. Physicians and nurses, in turn, must build a relationship of trust with the patient, have resources to guide them through the change, resist the temptation of defensive medicine, and overcome the long-standing problem of time constraints.

The challenges for health systems are equally numerous: from the time dedicated to training and implementation, to the commitment to training and providing regular feedback, to organizing staff dedicated to deprescribing and identifying process and outcome indicators — not to mention engaging citizens and aligning reimbursement systems and quality incentives with deprescribing. “Less can be more,” said Kirchmayer, adding, however: “if we build the trust, the tools, and the teams needed to make it happen.”

Training, Organizational Models, and Research

Global attention to deprescribing continues to grow, as reflected in the many national and international networks that have emerged in recent years. But bringing this approach into everyday clinical practice will take a multipronged effort. According to Trifirò, there are at least three key areas.

“We need to act on training,” he told Univadis Italy, noting that in Italy, alongside university courses, there is also a program sponsored by 12 scientific societies at the University of Verona, with 70 participants from across the country representing all healthcare settings. Equally important are organizational models because attention to specific issues tends to increase when dedicated services are established, Trifirò said, pointing to the strong results achieved through the Verona service. Last but not the least is research, including the methodological and other challenges these studies involve.

For deprescribing to become a routine part of daily medical practice, collaboration will also be essential among the professionals involved — including pharmacoepidemiologists, clinical pharmacologists, and physicians, especially primary care physicians — along with a sustained effort to build trust with patients. Technology can help as well.

“There are several tools that help determine when a medication might be discontinued. We are also developing one that takes many variables into account at the same time and could support physicians in their treatment decisions,” Trifirò said, adding that he remains optimistic about the future of deprescribing and sees substantial room for improvement across the three areas he identified.

This story was translated from Univadis Italy, part of the Medscape Professional Network.