Discontinuing Drug Therapy in Patients With Limited Life Expectancy
The randomized clinical trial “Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness” evaluates a timely and important topic. It is refreshing to review a trial evaluating the discontinuation of a therapy. Clinicians often feel compelled to add medication to treat a patient, but far less inertia for discontinuing a drug.
This unblinded clinical trial evaluated patients with a life expectancy between one month and one year who were on a statin for more than three months. The participants were on statins for either primary or secondary prevention of cardiovascular disease and did not have recent active cardiovascular disease.
Three hundred and eighty one patients were enrolled, 192 received statin therapy, and 189 were randomized to discontinue their statin. There was no statistical difference in total or cardiovascular mortality between the groups. Total quality of life was slightly better in the group randomized to discontinuing statin therapy.1
Patients at the end of life are often on multiple medications which are no longer of benefit and have potential harmful effects. There is limited data regarding withdrawal of medications and evaluation of this intervention on patient outcomes. This trial demonstrates that stopping statin therapy is a reasonable option in patients at the end of life. The potential for a slight improvement in quality of life noted in this study and decreased patient costs are important outcomes to discuss with patients and their families.
I applaud the investigators for conducting a randomized trial on discontinuing a medication. Although this trial focused on statin therapy, evaluating all our patients' medications and the potential benefits and harms the medications may have is an essential component of patient management.