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Trial registered on ANZCTR
Registration number
ACTRN12610000865011
Ethics application status
Approved
Date submitted
14/10/2010
Date registered
15/10/2010
Date last updated
24/01/2012
Type of registration
Retrospectively registered
Titles & IDs
Public title
Systematic Termination of Pharmaceutical Agents Trial (STOPAT): a pilot randomised trial of stopping drug therapy
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Scientific title
Systematic Termination of Pharmaceutical Agents Trial: A pilot (feasibility) randomised controlled trial of deprescribing
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Secondary ID [1]
252881
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Nil
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Universal Trial Number (UTN)
Nil
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Trial acronym
STOPAT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Polypharmacy
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Condition category
Condition code
Public Health
258579
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0
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Other public health
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Gradual withdrawal of one target medication selected from a defined list of Target Drugs (antihypertensive therapy, anti-anginal therapy, diuretics, non-steroidal anti-inflammatory drugs and COX-2 inhibitors). Dose reductions are made at two weekly intervals by general practitioner if participant remains clinically stable, until target drug has been ceased for two weeks.
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Intervention code [1]
257408
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Other interventions
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Comparator / control treatment
Usual care continues in the control group (ie the protocol does not specify any change to management of these patients. Medication therapy can be amended by treating general practitioner as clinically indicated).
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Control group
Active
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Outcomes
Primary outcome [1]
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Proportion of intervention participants in which successful medication withdrawal could be achieved (defined by patient self report)
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Assessment method [1]
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Timepoint [1]
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At conclusion of study. Each participant is assessed at two weekly intervals until i) target medication has been ceased for two weeks; or ii) further dose reductions are not possible (because participant is not clinically stable).
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Secondary outcome [1]
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Quality of life: SF-36 and EQ5D visual analogue scale
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Assessment method [1]
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Timepoint [1]
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Each participant is assessed at baseline and at two weekly intervals until i) target medication has been ceased for two weeks; or ii) further dose reductions are not possible (because participant is not clinically stable).
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Secondary outcome [2]
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Medication adherence: Morisky medication adherence scale
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Assessment method [2]
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Timepoint [2]
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Each participant is assessed at baseline and at two weekly intervals until i) target medication has been ceased for two weeks; or ii) further dose reductions are not possible (because participant is not clinically stable).
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Secondary outcome [3]
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sleep quality: Pittsburgh Sleep Quality Index [PSQI]
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Assessment method [3]
265983
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Timepoint [3]
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Each participant is assessed at baseline and at two weekly intervals until i) target medication has been ceased for two weeks; or ii) further dose reductions are not possible (because participant is not clinically stable).
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Secondary outcome [4]
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cognitive function: mini-mental state examination [MMSE]
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Assessment method [4]
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Timepoint [4]
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Each participant is assessed at baseline and at two weekly intervals until i) target medication has been ceased for two weeks; or ii) further dose reductions are not possible (because participant is not clinically stable).
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Eligibility
Key inclusion criteria
i) participant taking at least one drug included in the Target Drug List (antihypertensive therapy, anti-anginal therapy, diuretics, non-steroidal anti-inflammatory drugs and COX-2 inhibitors);
ii) participant has stable chronic disease with respect to the medication targeted for withdrawal
iii) patient reports at least one negative symptom ascribable to the drug therapy (effects specific to drug class, or possible adverse effects such as falls, confusion, malaise and nausea), or the patient is taking more than 5 drugs concurrently
iv) treating physicians concur with randomisation.
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Minimum age
60
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
i) patient is taking warfarin
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants were openly assigned to intervention or control groups using a randomisation table
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Prospectively created using a computerised random number generator.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/10/2007
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
40
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Royal Perth Hospital Medical Research Foundation
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Address [1]
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GPO Box X2213
Perth WA 6847
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Royal Perth Hospital
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Address
Wellington St,
Perth WA 6000
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Country
Australia
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Secondary sponsor category [1]
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University
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Name [1]
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University of Western Australia
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Address [1]
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Stirling Hwy
Crawley WA 6009
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Country [1]
257053
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Royal Perth Hospital Human Research Ethics Committee
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Ethics committee address [1]
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GPO Box X2213 PERTH WA 6847
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
259882
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Approval date [1]
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12/09/2005
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Ethics approval number [1]
259882
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2006/006
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Summary
Brief summary
Therapy with several drugs simultaneously entails several hazards related to drug interactions and side effects. Analysis of individual patients often reveals that some drugs are either unnecesary, or at least thought to be so, either because the indication for them no longer exists or because they were injudiciously prescribed in the first place. In support of this point of view, up to 25% of all acute medical admissions to hospital are due to a clinical problem related to drug treatment. It has been shown that withdrawal of some drugs can alleviate a tendency to fall in elderly patients, and there is evidence that antihypertensive medication may be "down—titrated" (i.e. the dose may be reduced) without loss of antihypertensive effect. We wish to undertake a formal trial of drug withdrawal as a therapeutic maneouvre. As a preliminary we wish to establish that such a trial is feasible and safe and therefore propose a pilot study in a limited number of patients. We have also adopted a restricted list of drugs for the purposes of the pilot study in order to enhance the safety aspects of the trial. Participants will be randomised to persist with current therapy or to have the target therapy withdrawn. They will be followed up frequently. The end point for the ultimate study will be efficacy and quality of life measures but in this study we are interested in safety and practicability only, though efficacy and QOL will be assessed.
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Trial website
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Trial related presentations / publications
Beer C, Loh P, Peng YG, Potter K, Millar A. A pilot randomised controlled trial of deprescribing. Therapeutic Advances in Drug Safety 2011; 2(2):37-43. Beer C, Potter K, Loh P-K, Peng YG, Millar A. A pilot randomized controlled trial of deprescribing: STOPAT (Systematic Termination of Pharmaceutical Agents Trial). Basic Clin Pharmacol Toxicol 2011;109 (Suppl 1): 156
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Christopher Beer
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Address
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GPO Box X2213
PERTH WA 6847
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Country
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Australia
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Phone
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+61892242750
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Christopher Beer
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Address
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GPO Box X2213
PERTH WA 6847
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Country
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Australia
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Phone
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+61892242750
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Fax
5955
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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