Patients randomized to a self-administered electronic intervention had a significantly greater likelihood of complete benzodiazepine cessation compared with those who received treatment as usual.However, there was no difference in the second primary endpoint of at least a 25% dose reduction, or in secondary endpoints including self-reported anxiety symptoms and sleep quality.Experts noted that this intervention may be of interest only to patients already motivated to decrease use, though the findings are encouraging given the prevalence of benzodiazepine dependence.
Use of a self-administered electronic intervention led to cessation of benzodiazepines among long-term users, a randomized trial showed.
Among 161 patients at Veterans Health Administration primary care clinics, those in the electronic intervention group had a significantly greater likelihood of complete benzodiazepine cessation compared with those who received treatment as usual (OR 5.31, 95% CI 1.12-25.12), reported Keith Humphreys, PhD, of Stanford University in California, and colleagues.
However, there was no difference in the second primary endpoint of at least a 25% dose reduction at 6-month follow-up (OR 2.51, 95% CI 0.91-6.90), or in secondary endpoints including self-reported anxiety symptoms, sleep quality, and overall health and quality of life, the authors noted in JAMA Network Open.
A previous study showed that the intervention, known as Eliminating Medications Through Patient Ownership of End Results (EMPOWER), reduced long-term benzodiazepine use among patients receiving printed self-management materials and tapering strategies versus control patients, so the researchers decided to test the intervention via an electronic format.
“Findings from this replicated clinical trial are encouraging given the prevalence of benzodiazepine dependence and the constraints on clinician time available to address it,” Humphreys and colleagues wrote.
Humphreys told MedPage Today that he and his team would like to see this strategy rolled out to more places based on these results. “We now have two different studies showing something helps, and it was taxpayer funded so that’s our next hope, to introduce this to more medical centers and let them run with it and disseminate it, so more people can benefit.”
In an invited commentary, Marlise Pierre-Wright, MD, MPA, and Jeffrey A. Linder, MD, MPH, both of the Northwestern University Feinberg School of Medicine in Chicago, pointed out that only one-third of those approached for the study agreed to be randomized, and of those, only 12% stopped use of benzodiazepines.
This intervention “may be of interest only to patients already motivated to decrease benzodiazepine use,” they noted, and patients who most need to stop or taper these medications “may be the least likely to participate, may have the hardest time, and may need the most help.”
However, the study offers “encouraging evidence that simple, low-cost electronic tools can be distributed at scale and can also foster patient autonomy and engagement for patients willing to access these resources,” they wrote, adding that “we must also work in parallel to create tools for physicians who care for patients who are less engaged or who have limited access to technology.”
Humphreys acknowledged that those people who were not ready to have the feedback or open the discussion to reduce benzodiazepine use would not have agreed to participate in their study. But “like most of these apps, they’re there to help you do things you’ve decided you want to do and also to help you appraise if you want to do it,” he said. “We present information on the risks of benzodiazepines, which a lot of people are not aware of, so it’s possible some people became more motivated when they had that.”
EMPOWER-ED was a two-arm, individually randomized trial with a 6-month follow-up conducted at Veterans Health Administration primary care clinics in two VA healthcare systems in Central Arkansas and Minneapolis, and included 161 primary care patients taking benzodiazepines for 3 or more months. Mean age was 61.9 years, and 83.2% were men.
Patients were randomized to the electronic intervention on any platform, including smartphone, desktop, or tablet, or asked to continue to follow clinician recommendations on their benzodiazepine use (treatment as usual). Patients were excluded if they were receiving palliative care; had a current diagnosis of dementia, schizophrenia, seizure disorder, and/or spinal cord injury; were determined on screening to have acute suicidality; or had no access to a smartphone or tablet.
The intervention includes self-assessment of risk associated with long-term use, and information on possible treatment-related harms including drug interactions. “To support patients’ motivation and confidence in their ability to change, EMPOWER-ED offered vignettes of peers who had successfully stopped using benzodiazepines,” the authors noted.
They were also given information on alternative ways of managing sleep difficulties and/or anxiety, as well as recommendations for self-tapering of benzodiazepines, and a personalized tapering schedule based on their current dose and desired start date.