Interventions targeting the reduction or discontinuation of long-term use of benzodiazepine receptor agonists: protocol for an overview of systematic reviews

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Background Benzodiazepine receptor agonists (BZRAs) are commonly prescribed to treat anxiety and insomnia. Although guidelines recommend limiting prescriptions to short-term use (<4 weeks), BZRAs are often continued long-term. Due to the associated risks (e.g. memory impairment, falls/fractures), it is recommended that long-term BZRA use should be discontinued. Several systematic reviews have studied the effectiveness of pharmacological and non-pharmacological interventions targeting long-term BZRA use; however, an overview of the evidence across intervention types and healthcare settings is lacking. Aim To identify and narratively synthesise systematic reviews that assess the effectiveness of interventions targeting the reduction or discontinuation of long-term BZRA use. Methods An overview of systematic reviews will be conducted. Five electronic databases (MEDLINE, Embase, Web of Science, PsycINFO, CINAHL) will be searched for systematic reviews of randomised controlled trials of interventions targeting the reduction or discontinuation of long-term BZRA use in adults in any setting. All types and combinations of interventions are eligible for inclusion (e.g. psychosocial interventions, pharmacological interventions). Interventions will be evaluated against usual care. Article screening and data extraction will be conducted by two reviewers independently. Overlap in primary publications will be assessed by calculating the corrected covered area and graphically represented. Methodological quality of included reviews will be assessed using the AMSTAR-2 tool. Results will be synthesised narratively. The certainty of evidence will be assessed using the GRADE approach. Conclusions This overview of reviews will narratively synthesise the evidence from systematic reviews of the effectiveness of interventions targeting long-term BZRA use. The review will provide an extensive overview of the existing evidence, which will inform future research and policy decisions about interventions for reducing and discontinuing long-term BZRA use.

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