1 2 3 4 Multimorbidity commonly results in polypharmacy, often defined as the long term use of five or more prescribed drugs daily. Multimorbidity, defined as two or more chronic medical conditions, increases with age, with an estimated prevalence of 70% or more in older populations aged 65 years and older, and is accompanied by increased mortality, healthcare utilisation, hospital admissions, and prescription rates of long term drugs. In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. 62.2% (n=491) had в‰Ґ1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. Results 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care.

Correspondence to: N Rodondi (or on Twitter).

21Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

20Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.

19Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.

18Department of Primary School Education, University of Ioannina, Greece.

17Department of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein and Utrecht, Netherlands.

16Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

15Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.

14Institute of Hospital Pharmacy, Bern University Hospital, University of Bern, Bern, Switzerland.

13Institute of Health and Society, UniversitГ© Catholique de Louvain, Belgium.

12Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

11Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

10Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland.

9Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.

8Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.

7CTU Bern, University of Bern, Bern, Switzerland.

6School of Medicine, University College Cork, Cork, Republic of Ireland.

5Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium.

4Clinical Pharmacy Research Group, Louvain Drug Research Institute, UniversitГ© catholique de Louvain, Belgium.

3Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

2Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.

1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Sven Trelle, senior clinical trial expert 7,.

Maria de Montmollin, research fellow 1 2,.

Oliver Baretella, research fellow 1 2,.

Michiel Meulendijk, data scientist 15,.

A Clara Drenth-van Maanen, geriatrician 11,.

Corlina J A Huibers, research fellow 11,.

Ingeborg Wilting, clinical pharmacist 3,.

Shanthi Beglinger, research fellow 1 2,.

Nathalie Schwab, research coordinator 1 2,.

Katharina Tabea Jungo, research fellow 2,.

Bastiaan T G M Sallevelt, research fellow 3,.

X mirage trial closes