The figure identifies the proportion of gabapentinoid users among adults stratified by age (<65 vs Ն65 years), presence of diabetes, Elixhauser comorbidity index, and concomitant use of opioids (0-2 and Ն3 prescriptions) and benzodiazepines (any benzodiazepine prescription).

Systematic reviews and meta-analyses (SRMAs) and randomized clinical trials (RCTs) are considered the most robust and reliable forms of evidence to guide clinical practice. Previous research has demonstrated year-over-year increases in the number of published RCTs between 1950 and 2007 1 as well as increases in the number of published SRMAs through 2016. 2,3 The increase in SRMAs is needed to update cumulative evidence, 2 although some investigators speculate that SRMAs may also serve as "easily publishable units or marketing tools." 2,3 Given this context, we sought to compare publication trends overall and across clinical topic areas among SRMAs and RCTs over the past 22 years.Methods | We conducted a cross-sectional study of PubMedindexed SRMAs and RCTs published from 1995 to 2017 using the UNIX terminal window Entrez Direct (EDirect). EDirect is the primary text search and retrieval system of the National Center for Biotechnology Information. The inclusion start period was set to 1995 to account for previous systematic errors in PubMed's categorization of SRMAs prior to this time period. 3 Systematic reviews and meta-analyses were searched as a single category because PubMed indexes meta-analyses within systematic reviews, and up to 60% of systematic reviews include meta-analyses (Figure 1). 4 Medical subject headings (MeSH) were used to define clinical topic areas when the term was a major topic of an article using the following heuristic for MeSH categories: medical specialty, surgical specialty, surgical procedure, disease, and anatomic system where applicable. Searches for SRMAs used the terms Systematic Review[Ptyp] OR Meta-Analysis[Ptyp], whereas RCT searches used Randomized Controlled Trial [Ptyp]. The 18 medical and surgical topic areas included in this study are noted in

IMPORTANCE Therapeutic substitution offers potential to decrease pharmaceutical expenditures and potentially improve the efficiency of the health care system. OBJECTIVE To estimate potential savings through therapeutic substitution in terms of both overall and out-of-pocket expenditures of branded drugs when a generic in the same class with the same indication was available. DESIGN, SETTING, AND PARTICIPANTS Repeated cross-sectional study using the 107 132 individuals included in the nationally representative Medical Expenditure Panel Survey (2010-2012) along with their reported prescribed medicine use. The Orange Book, company financial statements, US Food and Drug Administration records, and published research were used for adjunctive information. MAIN OUTCOMES AND MEASURES Estimated excess expenditure due to branded drug overuse when a lower-cost generic in the same class with the same indication was available. RESULTS The study included 107 132 individuals between 2010 and 2012, of whom 62.1% (95% CI, 61.4%-62.8%) reported use of any prescribed medicine. A total of 31.5% (95% CI, 30.7%-32.2%) used a medication from an included drug class, whereas 16.6% (95% CI, 16.0%-17.1%) of the population used a branded drug from the included classes compared with 24.0% (95% CI, 23.4%-24.7%) who used a generic and 9.1% (95% CI, 8.7%-9.4%) who used both. In the included drug classes, the majority of the drugs were generics, with a total of 93.5 billion standardized doses compared with 47.4 billion standardized doses of branded drugs.

PURPOSE Statins reduce the risk of mortality and coronary artery disease in individuals at high cardiovascular risk. Using nationally representative data, we examined the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia, and other risk factors. METHODSWe analyzed data from the 2010 Medical Expenditure Panel Survey, a nationally representative survey of the US civilian noninstitutionalized population. The study sample had a total of 16,712 individuals aged 30 to 79 years. Those who reported filling at least 2 statin prescriptions were classified as statin users. We created multiple logistic regression models for statin use as the dependent variable, with cardiovascular risk factors and sociodemographic factors as independent variables. RESULTS Overall, 58.2% (95% CI, 54.6%-61.7%) of individuals with coronary artery disease and 52.0% (95% CI, 49.4%-54.6%) of individuals with diabetes aged older than 40 years were statin users. After adjusting for cardiovascular risk factors and sociodemographic factors, the probability of being on a statin was significantly higher among individuals with both hyperlipidemia and coronary artery disease, at 0.44 (95% CI, 0.40-0.48), or hyperlipidemia only, at 0.32 (95% CI, 0.30-0.33), than among those with coronary artery disease only, at 0.11 (95% CI, 0.07-0.15). A similar pattern was seen in people with diabetes. CONCLUSIONSIn this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events. This undertreatment appears to be related to placing too much emphasis on hyperlipidemia and not enough on cardiovascular risk. Recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.